News 6/8/18

Top News

A survey of clinical trials participants finds that 93 percent are willing to share their clinical data with university scientists and 82 percent are OK with researchers from for-profit companies looking at their information.

Participants mostly aren’t concerned with how their information is used, although around one-third worry that their data might reduce study participation, could be used for marketing, or might be stolen. They also don’t trust drug companies.

Previous studies involving biospecimens and EHR data found that patients were less willing to share, which is a seemingly contradictory finding since clinical trials data is a usually a superset of EHR data. The authors speculate that clinical trials participants trust researchers and are enthusiastic about contributing to their scientific efforts.

Reader Comments

From Former Insider: “Re: University of Iowa Health Care. Never had any internal controls. The leaders were given $30 million to spend and spend it they did! Everyone is being let go. A tremendous waste of Iowa taxpayer dollars.” UIHC says it needs $7.5 million to exit the UI Health Alliance and dissolve its ACO, which is operated as a separate non-profit, UI Health System. Within UI Health Ventures is Community Connect, a 50-FTE operation that is implementing EHRs in seven critical access hospitals and clinics. A previous audit found that Community Connect had poor data controls, inaccurate patient scheduling and billing, and sloppy financial reporting, which the university still hadn’t corrected six months after the six-month deadline passed. Community Connect’s Epic implementation work will be transferred to UI Health Care’s IT department, which UI Health Care CIO Lee Carmen told me in November back when the decision was made.

HIStalk Announcements and Requests

Wednesday was a busy day on the HIStalk server as I got the Athenahealth news out before anyone else, even the Boston Globe, meaning that over 500 folks were online simultaneously for a couple of hours but with no ill effect except some minor site slowdowns. Page views for the day ended up at over 12,000, which isn’t hugely higher than normal, but it’s the burst of activity that sometimes causes a “server not responding” error at the peak. I had some adjustments made a few weeks ago (after the VA contract news) and that might have helped. The all-time high remains at 17,327 page views on July 30, 2015 when the DoD announced its Cerner decision and even I couldn’t get in that day.

I missed listing some companies the other day who won’t be continuing their HIStalk sponsorship, so I’ll add some additional thanks and goodbyes to:

• Logicworks
• Learn on Demand Systems
• Salesforce
• Sutherland

Webinars

June 12 (Tuesday) 2:00 ET. “Blockchain in Healthcare: Why It Matters.” Sponsor: Quest Diagnostics. Presenter: Lidia Fonseca, CIO, Quest Diagnostics. Blockchain technology is gaining traction in many industries, including healthcare. It’s not only a hot topic, but is also showing promise with real-world applications. This webinar will share how blockchain may play a key role in the future of healthcare IT by helping to solve some of the industry’s challenges, distinguishing the hype from reality by discussing how it works, how it can impact healthcare providers, and its future application in healthcare IT.

June 21 (Thursday) noon ET. “Operationalizing Data Science Models in Healthcare.” Sponsor: CitiusTech. Presenters: Yugal Sharma, PhD, VP of data science, CitiusTech; Vinil Menon, VP of enterprise applications proficiency, CitiusTech. As healthcare organizations are becoming more adept at developing models, building the skills required to manage, validate, and deploy these models efficiently remains a challenging task. We define operationalization as the process of managing, validating, and deploying models within an organization. Several industry best practices, along with frameworks and technology solutions, exist to address this challenge. An understanding of this space and current state of the art is crucial to ensure efficient use and consumption of these models for relevant stakeholders in the organization. This webinar will give an introduction and overview of these key areas, along with examples and case studies to demonstrate the value of various best practices in the healthcare industry.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

Athenahealth shares took a sharp turn upward Wednesday on the news of Jonathan Bush’s resignation and the company’s plan to explore strategic alternatives. ATHN shares rose 4 percent Wednesday and another 1 percent Thursday.

HP will lay off between 4,500 and 5,000 employees by 2019 as part of its ongoing restructuring plans.

Meditation app company Headspace launches a new subsidiary that will focus on developing FDA-approved, prescription-strength meditation apps targeted at specific medical conditions. Founder Andy Puddicombe became a Tibetan Buddhist monk and trained with the Moscow State Circus before starting the company in 2010.

A New York bankruptcy court selects MTBC as the “stalking horse” primary bidder for the assets of Houston-based Orion HealthCorp, which offers revenue cycle services, practice management, and group purchasing. You might be appreciating the irony of a revenue cycle services vendor going bankrupt, but there’s more to the story – it was part of Constellation Healthcare Technologies, whose since-fired CEO Paul Parmar and his fellow executives have been charged by the DOJ for part in an elaborate $300 million fraud scheme involving phony acquisitions. He claims he earns $1 billion per year and he lives in a 39,000-square-foot mansion worth a few dozen million.

People

Steve Wretling (DaVita) joins HIMSS in the new role of chief technology and innovation officer.

Act.MD names Amy Vreeland (LifeImage) as chief commercial officer.

Altruista Health appoints Brad Kuebler (Agiliko) VP of technology operations.

Berkshire Hathaway Chairman Warren Buffett tells CNBC that he and JPMorgan CEO Jamie Dimon have selected a CEO for their healthcare venture with Amazon and will name the individual within the next two weeks.

Sales

• Regional physician network Georgia Health Select will implement population health management software from EQHealth Solutions.
• Greater Ormond Street Hospital for Children in London contracts with Hyland Healthcare for its OnBase content management technology.
• Landmark Hospitals (FL) chooses RCM software and services from HCS Interactant.
• Ballad Health (TN) will implement Epic in a two-year process that will kick off in 2019.
• In the UK, Royal Devon & Exeter NHS Foundation Trust officials sign off on an Epic implementation that will begin in September.

Announcements and Implementations

Midland Health (TX) goes live on Cerner.

Patientco adds customizable SmartFinance patient financing options to its line of payment technologies and services.

DrFirst adds pharmacogenomic test ordering to its Rcopia e-prescribing system.

Government and Politics

The DOJ charges the CEO of a chain of Midwest pain clinics and laboratories, along with four doctors, for running a $200 million fraud scheme involving the prescribing of 4.2 million dosage units of medically unnecessary opiates to Medicare beneficiaries who were either addicted to the drugs or selling them on the street. DOJ says the doctors also required patients to consent to receiving the maximum number of injections that Medicare would pay for. CMS stopped payment to one clinic and a lab when it found that 100 percent of their claims were not eligible, after which it says the defendants created new shell companies and swapped out signs on the company doors so the billing could continue. Prosecutors say 37-year-old CEO Mashiyat Rashid lived in a $7 million mansion, drove a Lamborghini and Rolls Royce Ghost, and wore expensive designer clothes. Federal agents had him under surveillance last year when he withdrew $500,000 in 100-dollar bills from the bank, which his lawyer says is reasonable because he’s a venture capitalist. 

Privacy and Security

A presumably independent security researcher alerts consumer DNA testing company MyHeritage to an October 2017 data breach involving 92 million customer email addresses and passwords stored on an unauthorized server. The company may soon face scrutiny from the FTC, which is investigating the data privacy practices of competitors Ancestry.com and 23andMe.

Other

The Madison, WI hippie weekly says its time for Epic employees to unionize following the Supreme Court’s ruling that forcing employees into arbitration over labor issues and prohibiting them from filing class action lawsuits is legal. It adds that a union could also fight the company’s famous non-compete clause that prevents them from working at any Epic-using site, not just the company itself.

Over half of the 4,000 patients surveyed by University of Michigan Medical School researchers report that a physician’s attire is important and one-third admit it influences their level of satisfaction. Most prefer a white coat no matter the care setting, professional role, or gender of the provider.

Allscripts CEO Paul Black throws out the first pitch for the Healthcare Professionals Night at Wrigley Field for the Cubs vs. Phillies game. Not to be nitpicky, he’s not a healthcare professional even though Allscripts paid for the promotion. 

I wrote about the tiny California town whose one-bed hospital would either be sold to the only private investor who wanted it or be closed. They voted to sell Surprise Valley Community Hospital to 34-year-old Beau Gertz (above, right), the owner of nutraceutical and lab companies who plans to run his lab and telemedicine bills from all over the country through the hospital to earn higher payment. The hospital tried that previously with another company that left them high and dry. Apparently the main claim to fame of Cedarville, CA is that it’s the last chance to gas  up on the way to Burning Man.

The New York eHealth Collaborative expands patient care alerts for hospital admittance, discharge, and transfer across the state’s eight regional HIEs via the Statewide Health Information Network for New York.

Sponsor Updates

• Stanson Health’s Caden (Clinical Advisory Delivery Engine) goes live on Epic’s App Orchard.
• Lightbeam Health Solutions publishes a new case study, “Princeton HealthCare System Reduces Inpatient Admissions 15% using Care Management.”
• LiveProcess publishes a self-assessment quiz on the CMS Emergency Preparedness Rule.
• LogicStream Health receives the 2018 MedTech Breakthrough Award for Clinical Efficiency Innovation.
• Meditech will exhibit at the 2018 Nurse and Home Care Forum June 13-15 in Foxborough, MA.
• Netsmart will exhibit at the I2I Center for Integrative Health Spring Policy Forum June 11 in Raleigh, NC.
• DocuTap wins a MedTech Breakthrough Award for Best EHR Service; its Clockwise.MD technology wins in the Best Overall Patient Engagement Company category.
• Kyruus wins a MedTech Breakthrough Award  for best patient scheduling solution.
• Leidos Health will develop health IT for Maxim Healthcare Services and its post-acute care workforce.
• Glytec incorporates Smart Meter’s iGlucose diabetes care solution with its Glucommander Outpatient software.

Blog Posts

• Freeing Trapped Data for Health Research: It is Possible (Liaison Technologies)
• Virginia Medicaid Expansion (MedData)
• Epic Implementation at Integris Health (Optimum Healthcare IT)
• Here’s how 4 organizations are leveraging IT to address social determinants of health (Advisory Board)
• How to Start an Information Governance Initiative (Dimensional Insight)
• 3 Clever Ways to Get More Out of Your EHR (Spok)
• Winning Partnerships: How to make rural IT hosting relationships work (Meditech)
• Yes, you can strengthen portal security without disrupting patient satisfaction (Experian Health)
• Consultants as Business Partners: Cost Consciousness and the Bigger Picture (Pivot Point Consulting)
• Does Opaque Drug Pricing Affect Consumer Trust in Medicine? (PokitDok)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

EPtalk by Dr. Jayne 6/7/18

Quite a few of my clinical informatics colleagues do public health work and the discipline is certainly part of the informatics board exam. I enjoyed this article mentioning the return on investment for public health interventions. As the article notes, funding for public health is low because “the private sector can’t make money on it.” Many of the interventions are long-term plays, such as the return on investment for vaccinations or disease prevention. In many situations, by the time the “savings” happens the patient will be on Medicare, so unless there’s a shorter-term benefit payers might not be willing to spend the money.

Given the current mobility of our work force, employers are challenged to see return on investment for the longer-term conditions as well. Even in this high-tech day and age we still struggle with things like safe drinking water. It’s not just in underdeveloped nations – it’s in places like Flint, Michigan. Even if spending on public health didn’t have demonstrable ROI, it’s something we should simply consider as the right thing to do for the future of humanity.

I just finished reading Atul Gawande’s book “Being Mortal,” which should be required reading for broad segments of the population, such as people who have elderly relatives or anyone who might at some point be elderly, which is (hopefully) most of us. I’m a huge fan of his work and now that I’m at a point in my life where handling affairs for elderly relatives is a reality, it was a timely read. It’s good for those of us who live on the bleeding edge of all kinds of healthcare technology to think about the value of interventions and, as Gawande says, “what matters in the end.”

Speaking of reading, one of my favorite professional journals is Family Practice Management, put out by the American Academy of Family Physicians. Historically, family medicine residency programs have put an emphasis on being able to actually run a successful practice, not just learning the medicine, and the journal cuts to the chase on many of the financial issues that primary care physicians face today. The journal’s online “In Practice” blog addressed quality reporting this week, simplifying some principles that I know many physicians are not thinking about when they consider MIPS quality measures reporting.

Here’s the Cliffs Notes version for those of you who advise physicians in this area. Because they care about their patients, physicians are often tempted to report on measures that have clinical significance to their practice, or on measures that they know they are doing well on. However, this doesn’t take into account the fact that MIPS quality reporting is based on performance to a benchmark and that decile scoring is involved. Even though a provider might do the “right” action 90 percent of the time, which sounds like good performance, if the rest of the world is performing that action 95 percent of the time, the provider may receive fewer points than they expect because they’re actually a low performer relative to benchmark. Some of these measures are also considered “topped out,” where the benchmarks are high enough that it’s extremely difficult to make it into the top decile.

Physicians may also not be aware of bonus points available for high-priority measures or certain reporting strategies. For providers trying to navigate MIPS and other programs on their own, it’s very challenging to understand all the nuances. I would encourage them to reach out to their professional societies to see what guidance is available, whether by specialty, region, or practice type.

The American Academy of Family Physicians does a fair amount of advocacy work for docs in the trenches. I applaud their recent efforts to encourage major national laboratory vendors such as LabCorp and Quest Diagnostics to improve reporting mechanisms so that data is more easily shared among care teams in value-based care paradigms. They’re also encouraging the labs to facilitate data sharing for small practices so they can more easily stay in the game and not be burdened by interface and other costs.

I’d love to see AAFP get into the fray with them (along with many other labs) about reporting LOINC data with results. LOINC codes are critical to strong performance in several reporting arenas, and when codes aren’t sent, it can result in low data quality or large amounts of manual work for practices to try to map results to codes. The latter can be problematic due to many LOINC codes for tests that are similar but not identical, resulting in errors.

I used to provide LOINC mapping for my clients, but there ended up being so much back-and-forth with the performing laboratories and too little information available in their online test directories to the point where I couldn’t make it a cost-effective offering. Ultimately, the performing laboratory is in the best position to know exactly what test they are performing and which methodology is being used, which drives the code. I’d like to see reference labs be mandated to provide the codes in results transmissions so that providers can have solid data.

Failing to require labs to send LOINC codes reminds me of requiring physicians to e-prescribe but not mandating that pharmacies deploy systems that can accept electronic prescriptions. Our patients deserve better and it’s time for non-provider parts of the healthcare system to start ponying up.

It’s never too early to begin shopping for great shoes for HIMSS parties, so I was delighted when a friend sent me a pic of these sparkly numbers. Alas, they’re halfway across the country, so I won’t be getting them, but they give new meaning to the term “reach for the stars.” Speaking of HIMSS, now that it’s summer it’s probably time for me to think about booking my hotel so I don’t get stuck riding the shuttle bus from somewhere in conference Siberia.

Email Dr. Jayne.

Morning Headlines 6/7/18

Trump seeks to reorganize the federal government

White House officials plan to propose a reorganization of the federal government that would consolidate welfare programs under HHS – a move that would necessitate renaming the department.

HP sees up to 5,000 job cuts as part of restructuring plan

HP expects to lay off between 4,500 and 5,000 employees by 2019 as part of restructuring plans originally announced in 2016.

MyHeritage Statement About a Cybersecurity Incident

Consumer DNA testing company MyHeritage alerts customers to a data breach that compromised the email addresses and passwords of 92,283,889 users.

A meditation app loved by Wall Street and Silicon Valley wants to unveil a prescription-strength version with FDA approval

Headspace launches new subsidiary Headspace Health with an eye towards developing FDA-approved, prescription-strength meditation apps targeted at specific medical conditions.

HIStalk Interviews Thomas Charlton, CEO, Goliath Technologies

Thomas Charlton is chairman and CEO of Goliath Technologies of Philadelphia, PA.

Tell me about yourself and the company.

I started my career talking to surgeons about the benefits of minimally invasive surgery and the impact on patient care. Way back then, 25 years ago, health IT was an afterthought. Now I’m back talking to health systems and the IT departments about the impact on patient care from an IT perspective. It’s interesting how things have come full circle and healthcare has changed so much.

Goliath Technologies focuses on creating software to ensure that when clinicians or healthcare workers attempt to access electronic patient records, they can do so without struggling with application access. We want them focused on patient care, not fumbling around with applications.

We sell tourniquets at Goliath Technologies, not vitamins. If you are an IT pro — and those are our customers — and you’re having problems with end user experience issues, especially as it relates to clinical and business applications in a healthcare setting, we may have software that can help stop the bleeding.

What kinds of performance issues do you see with EHRs and hospital infrastructure such as Citrix?

I would say about 90 percent of the performance issues occur at one of three stages of the user experience. One is logon initiation — they’re having trouble accessing the application. Two, the logon is slow — they’re trying to log on to the application, they’re getting through a few screens, but the overall process is slowing them down from accessing the application. Then, it’s in-session performance as we call it, whether it’s Citrix or VMware Horizon, which we’re seeing more of. Regardless of what the clinical application or the EHR application is, whether it’s hosted or on-premise, they have problems in the same three key areas.

About five years ago, we started bringing out technologies that focus very considerably on helping folks anticipate, troubleshoot, and then prevent issues in those three areas. We dig very, very deep and get tremendous amounts of metrics and data to try to be able to help them solve the performance issues in those three key areas — initiation, logon duration, and session performance.

I would assume those system vendors are happy that you can either fix the problem or at least prove that their application isn’t the cause of it. How do your customers work with those vendors as they try to get to the bottom of the issue?

It has really taken off. We have two very forward-looking vendors, Cerner and Epic. Cerner now resells Goliath Technologies products, so they can sell our technology into Cerner hospitals. We have a lot of very large Cerner hospitals. UHS, which I believe is a top 10 for-profit health system, is a big Cerner customer. I believe they’re the top 15 in Cerner, but they’ve been a customer of ours for years.

Epic has started the Epic Orchard program that gives performance vendors like ourselves access to Epic application data and information to correlate that with end user experience and IT delivery infrastructure data.

These forward-looking vendors realize that performance issues — standard, everyday IT performance issues, whether you’re on-premise with Epic or hosted with Cerner — impact the end user experience. A lot of the finger-pointing goes to Cerner.

I can give you one very good example with UHS. They were having downtime at a particular hospital. They opened a support ticket with Cerner. There was quite a bit of frustration. They had our technology on-premise, and there’s a real key component here — they had a problem with WiFi. It had nothing to do with Cerner. Of course, everybody sees Cerner on the console, so that’s who they blame. We found out that it was an on-premise WiFi issue that was causing the downtime.

We have situation after situation where that occurs. Our technology looks at things outside of the application that can cause problems with accessing the application or using the application.

You’ve introduced a cloud monitoring product for AWS and Azure. What healthcare demand are you seeing for it?

That remains to be seen. If I could make a statement about movement to the public cloud, we’re seeing a lot of adoption of cloud-based services, but your formal IT organizations are doing a lot of moving to internal cloud, centralizing applications for efficiency and things of that nature. We’re just starting to see hybrid clouds in the enterprise, where Viacom is a big customer of ours and BBVA. They are moving small amounts of their infrastructure to the cloud.

At Viacom, for example, they’ve been using technology in the cloud to build websites for movies for years and years. They’ve used AWS, but traditional IT is moving slowly. It’s even more so the case in healthcare IT. They’re worried about other things. Not only do you lose a bit of control when you move to the cloud and there’s a cost associated with it, but then there are all the concerns around privacy and security. We’re not seeing the move to the cloud in healthcare that we’re even starting to see in the enterprise. I think it’s probably going to move a little bit more slowly.

What’s it like selling technology to hospitals versus other industries?

What’s very interesting about healthcare IT is that they are much more traditional in terms of their approach, and very pragmatic. Things tie back, oftentimes, to patient care. So when you think about the challenges in healthcare IT, there are three critical things that we see across the board in relation to their enterprise counterparts.

Budgets and headcount. Almost always, they’re about a half to a third of what their enterprise counterparts would be. If you’re a health system and you’re supporting 5,000 users, your IT budget and your staff is probably about half of what a similarly-sized enterprise would be.

Desktop virtualization. A huge challenge. Healthcare uses desktop virtualization in a considerable fashion to access the clinical and business applications that they use because it provides them with secure access. But that also adds complexity, on top of the fact that they have smaller IT staffs.

Patient care is at the root and gives a little bit different focus. You may have a marketing person, a salesperson, or a developer who can’t access their application in an enterprise, and that’s one thing. But when you have a surgeon, physician, or clinician who can’t access patient records when they’re trying to have an interaction with the patient — or, God forbid, the patient is on the table, so to speak, in a clinical setting — that adds a considerable amount of focus.

When we deal with healthcare versus enterprises, there seems to be a little bit more focus and a little bit more sense of urgency to solve these particular issues. The underlying current is that everyone is concerned about patients. It’s a little bit more critical on the healthcare side than it seems to be on the enterprise side.

You were described in a 2002 profile as being an aggressive leader who pushes employees hard, puts performance monitoring in place, and then gets results from companies that were previously struggling. Have you changed your approach? What problems do you most often see in companies?

That was an interesting article. You have to take an article like that and put it up against the common sense and logic test. That was Silicon Valley, and Silicon Valley certainly went through the dot-com boom or bust for awhile. But things have not changed a whole lot in Silicon Valley. If someone doesn’t like where they’re working or they believe they’re being pushed too hard, they can always go work somewhere else.

I’ve done five other companies since then, Goliath Technologies being the latest. All of those five companies were successful turnarounds. Some led to exits, built a lot of shareholder value, and launched a lot of careers for people.

What was missing in that article, and what I’ve seen consistently — and I’m talking about taking over companies in New York, Israel, Canada and different parts of the United States — is that regardless of generation, there are people who are extremely driven and want to prioritize advancing their careers, for whatever reason, over doing other things. It’s talked about in terms of being aggressive and hard-driving, but really I was very lucky to be engaged with teams where there were lots and lots of hard-driving people.

I honestly don’t philosophically think that you can drive anybody. You want to find driven people and then create the type of an environment where those types of driven people want to come and have a long-term career.

Do think it’s your personality or the rigor with which you approach the business with an end goal in mind that makes you successful?

I say to people all the time when we’re interviewing them that we are in the people business at Goliath Technologies. When I was taking over venture capital-backed businesses, I used to get pushback from the boards many times for the amount of money that I would spend on training, ongoing education, and my focus on promoting people from within. My father brought this up to me one time. He said, you’re in the software business. There’s no plant. There’s no equipment. There’s no collateral. There’s people. You’re in the people business. You just happen to build software.

People come up with the ideas. Other people take those ideas and turn them into workable products. Other people then market, sell them, and then support those customers on an ongoing basis. We are in the people business. We just happen to sell software.

Do you have any final thoughts?

As an organization, we will be very successful if we focus very intently on two things — the careers of our employees and solving problems for our customers. The marketplace is moving in our direction. There’s an increasing reliance on desktop virtualization. The major EMR/EHR vendors are coming to the realization that outside of their application, there’s a tremendous amount of IT infrastructure that can impact the end user experience with their application, and therefore, their brand and reputation. Organizations like Cerner and Epic are working with us now in a formal partnership.

We will focus on employees and customers and ultimately be proud of what we’re doing to positively impact patient care.

Book Review: “Bad Blood”

I’ll save you the $13.99 Kindle price right now. Theranos was a fraud in every possible way. Elizabeth Holmes was its paranoid, money-fixated mastermind who was enabled by media that were enchanted with the crowd-pleasing and unfortunately rare story of a young, female Silicon Valley founder. Holmes didn’t care a bit that patients were endangered by the company’s entirely inaccurate blood testing system. She was a paper multi-billionaire until a series of exposes in the Wall Street Journal took the company down and put her on “healthcare’s most reviled” leaderboard ahead of Martin Shkreli. Thanks for coming out, I’m here all week, try the veal.

Or, maybe the $13.99 is worth it just to see how the company used its heavyweight legal team and connections to keep the scam alive. Or for the guilty pleasure of reading how Holmes sweated as the noose tightened, eventually going all Hitler in the bunker as she realized that at 34, she would never be trusted or taken seriously again.

You’ll like John Carreyrou’s book if you’re a fan of “All the President’s Men” or “Spotlight” and would enjoy the dramatic (and overly dramatic at times) account of how the reporter bagged the story of a lifetime and then got to double-dip his WSJ salary by repurposing his work into a bestseller. He’s probably worth a lot more than Holmes at this point.

Everything about the company was an elaborate hoax and so was Holmes, coached to ditch her thick glasses, speak in a creepily low register, wear black turtlenecks, and make lofty pronouncements about changing the world. She was like a lipsticked Steve Jobs except her fake voice was deeper, she was even better at milking the reality distortion field except to commit fraud instead of inspire achievement, and instead of kicking a dent in the universe, she was sent kicking and screaming into shame and ridicule (with a vacation behind bars a distinct future possibility).

Like Jobs, she was petulantly demanding, leaving a trail of fired employees and board members who dared question whether the empress was indeed wearing any clothes other than that ever-present turtleneck. Her 20-member armed security detail marched out employees who questioned the company’s patient-endangering technology that never worked. She oversaw her empire from an office she had designed as a replica of the White House’s Oval Office, which is about as weird as you can get.

The book opens with the company’s CFO playing his dutiful Silicon Valley role in inflating his already-inflated financial projection at Holmes’ insistence that she needed one of those hockey-stick growth charts like everybody else in Silicon Valley trots out while trying to keep a straight face. The CFO wasn’t too inquisitive about why Holmes refused to show him the drug company contracts on which his fantasy financials were based. His downfall came when he questioned Holmes about a demonstration of her blood testing machine that he knew didn’t actually work, charging Holmes (accurately) with simply faking the whole thing. She fired the CFO on the spot and the board didn’t press her for a reason (hello, clueless board). He was the company’s first and only CFO – despite heavy investment and a $9 billion paper company value, Theranos never had one again (hello, clueless investors).

Holmes dropped out of Stanford’s chemical engineering program after two semesters and wrote a patent application for an arm patch that would both diagnose and treat medical conditions. Her only fear in life was needles, which she vowed to eliminate for blood draws in favor of a finger stick, which sounds great to a 22-year-old college dropout who didn’t know or didn’t care that entire companies are filled with experts who have tried and failed to make that idea work. The sample size is too small, the dilution is too error-fraught, the repeated microfluidic flow through the testing machine is too complicated, and the skin material that is sucked up along with the blood always throws the results off.

Asked to describe how its product works, Holmes provided The New Yorker with a “comically vague” explanation:

A chemistry is performed so that a chemical reaction occurs and generates a signal from the chemical interaction with the sample, which is translated into a result, which is then reviewed by certified laboratory personnel.

Despite having no product, the business plan Holmes cooked up was brilliant. She envisioned drug companies paying her fortunes to perform home blood testing of clinical trials subjects, claiming that real-time reporting could save them 30 percent of their research costs and alert them to stop the therapy if patients experienced problems. Holmes was healthcare illiterate, but at least she knew that in search of health riches, you go where the money is (drug companies).

Holmes whipped employees into working crazy hours, spied on their email and telephone calls, hired private investigators to follow them, and didn’t allow company groups to interact with each other for fear of compromising her intellectual property. Her second-in-command was Sunny Balwani, her secret lover who was 18 years older than she. She marginalized the company’s board as “just a placeholder” that she charmed into giving her 99.7 percent of the voting rights, rendering the aged former heads of state and billionaires irrelevant as they joined the company’s investors in breaching their fiduciary duty. They treated her like a darling granddaughter who could do no wrong, smacking their lips approvingly at the inedible Easy-Bake Oven cake she proudly served them.

The blood testing technology didn’t work, so engineers jury-rigged a glue-dispensing robot to move pipettes around. Holmes immodestly named it the Edison. It was fraught with the same problems that plagued everything that Theranos ever designed – it could perform only a few tests, it wasn’t suitable for home use, and it ran only one sample at a time. Most importantly, it delivered inaccurate results. She had a very slick, Apple-looking case designed for it, though (it was not known to wear black turtlenecks).

Theranos ran an admirable “fear of missing out” scam on Walgreens, playing on that company’s fears that CVS would sign a deal first. Walgreens invested heavily even though Holmes refused to show them her lab and wouldn’t allow them to run side-by-side samples with commercial labs to verify the Edison’s accuracy (hello, clueless due diligencers).

Theranos avoided CMS and FDA oversight by claiming that its technology was “laboratory-developed tests” that fall between their respective jurisdictions, with the government predictably paying no attention. All Theranos had was a CLIA certificate and lab that was being run by a dermatologist with no lab experience. Holmes tried to work her connections to have the military use her product, only to become infuriated when a military expert said she would need an IRB-approved study and FDA approval. Holmes tried to get him fired. It didn’t matter anyway since she simply lied in claiming to anyone who would listen that the military was using Theranos in Afghanistan battlefields. She said it, so it must be true, and at some point she probably repeated it enough times to believe it herself.

Also scammed was the grocery chain Safeway, which envisioned a sexy future in wellness. It spent $350 million to add swanky Theranos testing stations to its stores somewhere back between the meat department and the rotisseried chickens.

Theranos started developing the MiniLab in 2010. Its only innovation over commercial machines was a smaller footprint for home and retail use. Holmes kept a straight face in calling it “the most important thing humanity has ever built.” She hired Apple’s former marketing company for $6 million to orchestrate a splashy product rollout and her own photo shoots.

Theranos couldn’t make its technology work in time to meet a Walgreens deadline, so Holmes simply bought a bunch of commercial blood testing machines and hacked them to try to make them work with the fingerstick samples. The friendly, fawning press asked no awkward questions. Her orchestrated fame emboldened her to fudge the numbers even more – she assured one investor that the company would make a $1 billion profit in 2015, while nearly simultaneously telling another investor that it would be $100 million. Her patient result numbers were equally all over the place, as the company performed untested processing on the modified commercial machines in its Phoenix-area rollout at Walgreens. They were just Fedexing samples back to California, which introduced another problem Theranos hadn’t thought of – the sweltering Phoenix summer sun was ruining the samples as they sat on hot Fedex planes. Doh!

The hoax started to unravel when a pathology blogger noticed that a paper Holmes co-authored had been published by a pay-for-play online journal in Italy and it involved a study of only six patients. The blogger contacted Wall Street Journal reporter John Carreyrou, who conducted his own test by having blood drawn at an Arizona Walgreens. He thought it was odd that it was a traditional needle draw rather than a finger stick, becoming even more puzzled when his same tests performed by LabCorp gave wildly different results.

While Carreyrou was investigating, the Theranos deception continued. The machines kept screwing up during demonstrations, so engineers rigged a “waiting” icon on display so the company could  blame connectivity problems and then run the samples later on commercial machines that actually worked. Holmes would encourage investors and reporters to have blood samples drawn in her offices and would show them the sample being inserted into the MiniLab, but as soon as they left, employees would pull out the sample and run it on a commercial lab machine.

In honor of a visit by Vice-President Joe Biden, Theranos built a fake lab in a conference room, stacking up non-functional MiniLabs and ordering employees to stay home in case anyone asked embarrassing questions.

Carryrou’s first article created a firestorm, although Business Insider’s Kevin Loria scooped him by a full six months in running a skeptical article quoting scientists in April 2015 – he really should get the credit. Many people defended Holmes, while others questioned how a medical company’s board and investors could have only healthcare-inexperienced people.

Holmes took to the airwaves to defend her company, proclaiming, “When you work to change things, first they think you’re crazy, then they fight you. And then all of a sudden you change the world.”

You know the rest. FDA declared the nanotainer to be an unapproved medical device. A surprise CMS inspection said Theranos was posing immediate jeopardy to patient health and safety. Holmes made Balwani her sacrificial lamb, firing him and breaking up with him. All Edison test results were voided, Walgreens and Safeway ended their Theranos partnership, Holmes was banned from the industry, and everybody involved sued Theranos, which had burned through $900 million of investor money and was rapidly going broke defending itself. As icing on the cake, the SEC began an investigation, declaring Theranos to have been a “massive fraud” from the beginning.

I’d like to think that most of us in healthcare eventually saw through the Theranos scam, or at least would have been skeptical enough to ask the questions that its investors and Holmes fanboys didn’t. The company made big claims without publishing peer-reviewed data. Its value proposition wandered – was the story the finger stick, the consumer access to blood tests, or the cost-lowering threat to LabCorp and Quest? Dropouts in their early 20s might well start technology companies like Facebook, but the Theranos board and leadership team were remarkably inexperienced and naive about healthcare and the huge players entrenched in it that had already already tried and failed to commercialize fingerstick testing. They also had the advantage that in terms of lab services, it’s all about draw-station locations and the economy of scale of running thousands of tests per minute through a highly automated factory, and Theranos would have needed to scale to thousands of times its volume to take even 1 percent of their market.

Theranos is a good reminder to healthcare dabblers. Your customer is the patient, not your investors or partners. You can’t just throw product at the wall and see what sticks when your technology is used to diagnose, treat, or manage disease. Your inevitable mistakes could kill someone. Your startup hubris isn’t welcome here and it will be recalled with great glee when you slink away with tail between legs. Have your self-proclaimed innovation and disruption reviewed by someone who knows what they’re talking about before trotting out your hockey-stick growth chart. And investors, company board members, and government officials, you might be the only thing standing between a patient in need and glitzy, profitable technology that might kill them even as a high-powered founder and an army of lawyers try to make you look the other way.

Jonathan Bush Resigns as Athenahealth CEO

Athenahealth President and CEO Jonathan Bush has resigned, effective immediately.

Executive Chairman Jeff Immelt and CFO Marc Levine will assume responsibility for day-to-day operations. Board member Amy Abernethy, MD, PhD of Flatiron Health will advise the company on data strategy.

Bush was the subject of misconduct allegations and the pressure of activist investor Elliott Management.

Athenahealth’s board is exploring a sale, merger, or other transaction involving the company, but will also consider continuing as an independent company. It has opened a search for Bush’s replacement as CEO.

Bush said in the announcement, “I believe that working for something larger than yourself is the greatest thing a human can do. A family, a cause, a company, a country – these things give shape and purpose to an otherwise mechanical and brief human existence. Athenahealth is a near once-in-a-life time example of such a thing. With that lens on, it’s easy for me to see that the very things that made me useful to the company and cause in these past 21 years are now exactly the things that are in the way. I cannot imagine a single organization more loaded with potential to transform healthcare.”

Board Chair Jeff Immelt said, “Athenahealth is the most universally connected healthcare network in the country and we believe there remains significant, unrealized value in the company. To ensure Athenahealth maximizes shareholder value and is best positioned to realize the full potential of its premier healthcare technology platform, the board has authorized a thorough evaluation of strategic alternatives, including a potential sale or merger or continuing as an independent company under new leadership. We approach this process with an open mind and a commitment to continuing to strengthen the company – including its rich data asset, platform strategy, and culture of innovation. We are fully focused on serving the best interests of our shareholders, employees and clients.”

Morning Headlines 6/6/18

Microsoft has acquired GitHub for $7.5B in stock

Developers flee the GitHub platform as rumors solidify that Microsoft has acquired the open source repository for $7.5 billion in stock.

Florida Hospital and GE Healthcare Partners to Build ‘Command Center’ to Guide Clinical Operations

Florida Hospital will develop a clinical operations command center for its nine campuses using GE Healthcare’s AI-powered Wall of Analytics.

Pentagon investigates White House doctor Ronny Jackson

The DoD’s OIG is investigating allegations about White House physician and one-time VA secretary nominee Ronny Jackson, MD, who has been accused of improperly providing sleeping pills, drinking on the job, and sharing the medical information of VP Mike Pence’s wife without her consent.

News 6/6/18

Top News

Apple releases an API that allows developers to build apps connected to Apple Health Records.

Third-party developers can create IPhone apps that use medical information that is stored in Health Records and HealthKit, which Apple says can connect to 500 hospitals and clinics. Doctors can also integrate the stored patient information into their ResearchKit study apps to replace health questionnaires.

Apple says developers are creating apps for medication tracking, disease management, nutrition planning, and medical research.

Reader Comments

From Over Easy: “Re: Athenahealth. What are the odds that Elliott Management is behind the sudden surfacing of the old domestic news of Jonathan Bush?” I can’t speculate, but Googling turns up accusations that the hedge fund that’s pressuring the company has used shady tactics in the past hoping to discredit resistant CEOs, including hiring investigators to spy on their families and neighbors in hopes of turning up something salacious. The hedge fund denies that it has ever done that. However, the timing of the sudden interest in 12-year-old court documents certainly seems suspicious, especially since they involve divorce and custody proceedings rather than criminal activity.

HIStalk Announcements and Requests

Designer Kate Spade has died at 55 in an apparent suicide. I mention this only because I received an email from the National Action Alliance for Suicide Prevention asking media to report such events responsibly and to recommend that anyone who needs help call the 24/7 National Suicide Prevention Lifeline at 800-273-8255, so it seems like a good time to get the word out, especially since we have a physician suicide problem in our own industry. 

Here’s a reminder to answer this week’s question if you’re so inclined. It’s a little-understood profession onto which you might shine some light.

Webinars

June 12 (Tuesday) 2:00 ET. “Blockchain in Healthcare: Why It Matters.” Sponsor: Quest Diagnostics. Presenter: Lidia Fonseca, CIO, Quest Diagnostics. Blockchain technology is gaining traction in many industries, including healthcare. It’s not only a hot topic, but is also showing promise with real-world applications. This webinar will share how blockchain may play a key role in the future of healthcare IT by helping to solve some of the industry’s challenges, distinguishing the hype from reality by discussing how it works, how it can impact healthcare providers, and its future application in healthcare IT.

June 21 (Thursday) noon ET. “Operationalizing Data Science Models in Healthcare.” Sponsor: CitiusTech. Presenters: Yugal Sharma, PhD, VP of data science, CitiusTech; Vinil Menon, VP of enterprise applications proficiency, CitiusTech. As healthcare organizations are becoming more adept at developing models, building the skills required to manage, validate, and deploy these models efficiently remains a challenging task. We define operationalization as the process of managing, validating, and deploying models within an organization. Several industry best practices, along with frameworks and technology solutions, exist to address this challenge. An understanding of this space and current state of the art is crucial to ensure efficient use and consumption of these models for relevant stakeholders in the organization. This webinar will give an introduction and overview of these key areas, along with examples and case studies to demonstrate the value of various best practices in the healthcare industry.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Here’s the recording of Tuesday’s webinar titled “Increase Referrals and Patient Satisfaction with a Smarter ‘Find a Doctor’ Web Search.”

Acquisitions, Funding, Business, and Stock

Microsoft acquires open source repository GitHub for $7.5 billion in stock. The company, whose income is generated by charging enterprise customers for private repositories, has never made a profit. Developers are apparently already fleeing the platform on rumors that Microsoft – which once called the open operating system Linux “a cancer” — was taking over. GitHub was valued at just $2 billion in 2015. VC Andreessen Horowitz will make over $1 billion on the sale from its $100 million investment in 2012.

Teladoc acquires virtual visit provider Advance Medical for $352 million. The Westwood, MA-based Advance Medical is the leading virtual care provider outside the US.

Teladoc shares are up 61 percent in the past year vs. the Nasdaq’s 22 percent rise, valuing the company at $3.4 billion despite increasing annual losses.

Sales

• Advocare will replace GE Centricity with EClinicalWorks for its 600 providers in New Jersey and Pennsylvania.
• Estonia’s Tartu University Hospital joins the TriNetX global research network to expand its clinical trials population internationally.
• North Mississippi Health Services selects Mercy Technology Services to install Epic’s ambulatory EHR.
• Johns Hopkins Medicine will implement the Voalte Platform at Johns Hopkins Bayview Medical Center and Sibley Memorial Hospital for voice calling, secure text messaging, and alarm management.
• Children’s Hospital Colorado chooses Mediware’s blood management solutions.
• Lawrence General Hospital (MA) selects Santa Rosa Consulting as its Meditech Expanse implementation partner.

People

Adam McMullin (Voalte) joins pharmacy technology vendor FDS as CEO.

Cantata Health promotes Jonathan Isaacs as CEO and hires Krista Endsley (Abila) as president.

Columbia University nursing and biomedical informatics professor Suzanne Bakken, RN, PhD is named editor-in-chief of JAMIA.

Announcements and Implementations

Penn State Health St. Joseph goes live on Cerner.

Ciox Health announces GA of HealthSource, a cloud-based clinical information-sharing platform that can extract information from disparate health records using artificial intelligence, optical character recognition, and natural language processing. Three modules were also announced: Clarity (release of information), Smart Chart (medical records aggregation into a longitudinal profile), and Vault (a patient- and provider-centric data repository). 

InstaMed publishes its annual healthcare payments trends report, with these findings:

• 75 percent of Americans question the value they receive from the nation’s $10,400 per capita cost of healthcare
• 65 percent of consumers say they would change providers to obtain a better payments experience
• 58 percent of providers rely on statements to collect patient money owed as “paper is the sandpaper of healthcare”
• Consumer out-of-pocket spending is growing rapidly to a projected $608 billion as high-deductible health plans and ever-increasing deductibles become common
• Annual health insurance premiums have risen to an average of nearly $19,000
• Nearly three-fourths of consumers can’t make sense of EOBs or bills and only nine percent of them can define the basic health insurance concepts of premium, deductible, co-insurance, and out-of-pocket maximum
• More people (40 percent) fear the cost of illness more than the illness itself
• Only 21 percent of consumers regularly use their provider’s patient portal
• 80 percent of consumers want to check in for provider visits on their phones and 65 percent would use a phone app to pay medical bills as mobile payments have increased to 24 percent of the total
• The survey found strong increases in the use of online payments, digital wallets, and automatic payment plans

Imprivata launches Mobile Device Access for fast clinical mobile device authentication.

Mary Meeker’s influential Internet trends report finds that:

• Smartphone sales and Internet user growth have slowed as more than half the world is connected, but people are spending even more time online, with US adults averaging 5.9 hours per day
• People are spending more on healthcare, which may drive improvements in office convenience, digitized transactions, and on-demand pharmacy services
• The reach of digital payments is increasing
• Data and data-driven personalization can be an important driver of customer satisfaction
• Social media discovery is driving some product sales
• Return on ad spending is going down, with “customer lifetime value” receiving more emphasis as a result
• Household debt is at its highest historical level as consumers spend more on housing, insurance, and healthcare but less on food, entertainment, and clothing

Florida Hospital will develop a clinical operations command center for its nine campuses using GE Healthcare’s AI-powered Wall of Analytics.

ZappRx expands its partnership with prior authorization services vendor PARx Solutions to cover gastroenterology, rheumatology, and neurology.

Government and Politics

The Defense Department’s OIG is investigating allegations about White House physician and one-time VA secretary nominee Ronny Jackson, MD, who has been accused of improperly providing sleeping pills, drinking on the job, and violating the privacy of the wife of VP Mike Pence by sharing her medical information with other providers.

The Department of Justice charges two nurse practitioners and a surgery technician with opioid distribution after they allegedly sold prescriptions that they wrote on a doctor’s stolen prescription pad. DOJ also announces that a 65-year-old family practitioner in North Carolina who also ran an office-based opioid treatment has pleaded guilty to trading opiate prescriptions for sex with at least seven female patients, billing Medicare and Medicaid along the way for office visits that didn’t actually happen.

An HHS OIG investigation finds that even though the number of Medicare Part D prescriptions for brand name drugs dropped 17 percent from 2011 to 2015, drug companies made 77 percent more money as they simply raised prices at six times the inflation rate, which then automatically raised Medicare’s cost since it is based as a percentage of list price.

Other

The 514 residents of Surprise Valley, CA grapple with whether to sell the town’s one-bed, bankrupt hospital to the 34-year-old owner of nutraceutical companies who wants to use it for billing insurance companies for lab tests and telemedicine visits. He already loaned the hospital district $2.5 million to allow the hospital to buy one of his businesses, allowing him to advertise that it’s a wholly-owned subsidiary of the hospital and to keep 80 percent of the resulting lab billing profits. The bankrupt hospital tried a similar arrangement last year with EmpowerHMS, which it says abandoned the hospital after facilities it owned were accused of billing at least $175 million for lab services to patients who weren’t seen at those locations.

A Stanford Medicine survey of 500 EHR-using primary care doctors finds that:

• Two-thirds of them think EHRs have improved care and say they’re at least somewhat satisfied with their systems
• 59 percent think EHRs should be overhauled
• More than half say that using an EHR detracts from their satisfaction and clinical effectiveness
• A 20-minute patient visit involves 12 minutes of interaction, eight minutes with the EHR, and another 11 minutes of after-visit EHR time
• Suggested short-term improvements are EHR user interface redesign, shifting work to support staff, and using voice recorders as scribes
• Suggested long-term improvements are improving interoperability, using predictive analytics, and integrating patient cost information into the EHR

“Bad Blood” author and Wall Street Journal reporter John Carreyrou partially blames business-friendly Arizona for the “giant, unauthorized experiment” in which Theranos used its faulty technology to process blood samples collected from patients at Walgreens in the company’s original “wellness center” rollout in Phoenix, also noting that Theranos and its lobbyists convinced state legislators to pass a law that the company mostly wrote itself that allows patients to get blood tests performed without a doctor’s order.

Blount Memorial Hospital (TN) says a “corrupted file” caused a three-day downtime of its physician group’s network in early May, requiring restoring from backups.

Examination of the work computer of former dean of Michigan State University’s School of Osteopathic Medicine – who retired after charges of sexual harassment and failing to oversee child sex abuser Larry Nassar — turns up pornographic images of women wearing MSU Spartan gear.

A consultant says that every state should develop an all-payer claims database to study healthcare trends and to allow building consumer transparency tools for cost and quality. Twenty states are working on them, but the author notes that California – which spends $367 billion per year on healthcare – has rolled out an incomplete system even though it would cost only around $20 million to do it right.

Weird News Andy thinks this idea is dope. California is giving drug users free fentanyl test strips in hopes of reducing overdoses caused by the 40 percent of heroin that contains the powerful narcotic.The Canadian company that sells the $1 strips warns that they were designed to test urine, not drug products, and says the tests shouldn’t give users a false sense of security.

Sponsor Updates

• Ready Computing offers an off-the-shelf solution that combined InterSystems HealthShare HIE and Clinical Architecture’s Symedical content management to give physicians a graphical view of test results, diagnoses, and treatments.
• Impact Advisors is named to CRN’s 2018 Solution Provider 500 list.
• Spok joins Zebra’s PartnerConnect channel partner program.
• HBI Solutions contributes to a journal article titled “Assessing Statewide All-Cause Future One-Year Mortality: Prospective Study with Implications for Quality of Life, Resource Utilization, and Medical Futility” that features the work of its solutions staff and clients.
• Change Healthcare, ACO Partner, and BCBS of Arizona announce successful results of a shared savings plan.
• The Boston Business Journal ranks Definitive Healthcare the 11th fastest growing company in Massachusetts.
• Nordic is named to Inc. Magazine’s “Best Workplaces” list.
• AdvancedMD will exhibit at Masters in Ophthalmology June 8-10 in Orlando.
• Aprima will exhibit at the NJMGMA Practice Management Conference June 6-8 in Atlantic City.
• Arcadia will exhibit at the Millenium Alliance Healthcare Payers Transformation Assembly June 7 in Marana, AZ.
• Bernoulli receives the Best Research Paper award from AAMI Journal Awards for the paper, “Continuous Surveillance of Sleep Apnea Patients in a Medical-Surgical Unit.”
• Burwood Group will exhibit at the NCHICA Academic Medical Center Security & Privacy Conference June 11-12 in Chapel Hill.
• Centrak will exhibit at APIC 2018 June 13-15 in Minneapolis.
• EClinicalWorks will exhibit at the Value-Based Summit Series Telehealth 2018 June 7-8 in San Diego.
• FormFast will exhibit at the AZHIMA Annual Meeting June 14-15 in Mesa.
• Healthfinch will exhibit at the Healthcare Call Center Times event June 13-15 in Pittsburgh.
• Huntzinger Management Group EVP and Partner William Reed will speak at the Investment and M&A Opportunities in Healthcare Conference June 6 in Nashville.
• CRN names Impact Advisors to its 2018 Solution Provider 500 list.
• Intelligent Medical Objects will exhibit at the NextGen Large Client User Group Meeting June 6-8 in Chicago.
• Kyruus will exhibit at the Healthcare Transformation Summit June 7-8 in Austin, TX.
• EY names Collective Medical’s Chris Klomp, Adam Green, and Wylie van den Akker Entrepreneur of the Year 2018 Utah Region Award Winners.

Blog Posts

• Executive Q&A with Dr. Edmondo Robinson (Qventus)
• Top 5 Reasons for Surgical Services Delays (Access)
• AdvancedMD Certified Great Place to Work (AdvancedMD)
• Time for your annual physical – and genetic screening test? (Advisory Board)
• The Value-Based Care series – Episode #4: Collaboration and Communication (Agfa Healthcare)
• Top Revenue Cycle Blogs You May Have Missed (Leidos Health)
• #Traverbal With Me (Bluetree Network)
• Winning Partnerships: How to Make Rural IT Hosting Relationships Work (Meditech)
• May Conference Roundup: Datica on the Main Stage at MSBuild and HLTH (Datica)
• Security, Scale, Control: Leveraging the Power of Cloud Technology with Google Cloud (Burwood Group)
• Healthcare AI: Game Changers for Medical Decision-Making and Remote Patient Monitoring (CareSync)
• 3 Lessons Analytics Leaders Can Learn from the Sports World (Dimensional Insight)
• Optimum Healthcare IT: Redefining ERP in Healthcare (Optimum Healthcare IT)
• One Dinosaur’s Evolution to Embrace Change – A True Story (Impact Advisors)
• Tips to Successfully Navigate EHR Training (Optimum Healthcare IT)
• Helping NYC Youth Reach Their Potential (EClinicalWorks)
• Virtual EHR Training: 6 Benefits That You Can’t Ignore (The HCI Group)
• Think Outside the Classroom (HCTec)
• Blockchain 101 – What Exactly is Blockchain? (HealthCast)
• One Dinosaur’s Evolution to Embrace Change – A True Story (Impact Advisors)
• Reputation Management for Doctors (Influence Health)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

Morning Headlines 6/5/18

Apple opens Health Records API to developers

Apple announces that it will give users the ability to share health data stored on their devices with third-party developers and researchers.

Judge rules Theranos investors cannot pursue class action

A California judge rules that over 200 Theranos investors can’t pursue a class-action lawsuit against the company, which they claim defrauded them out of millions of dollars.

Teladoc Acquires Global Virtual Care Provider, Advance Medical

Teladoc acquires Advance Medical, a telemedicine company serving Latin American and Asian markets, for $352 million.

Curbside Consult with Dr. Jayne 6/4/18

From time to time, I get together with one of my colleagues from residency to catch up on what’s going on in the primary care community. We used to be able to make it happen quarterly, although as her practice has gotten busier and as her children have gotten older, it’s more and more difficult to do. We last got together almost a year ago, and then had a flurry of rescheduling and canceling until we finally arrived at the following summer.

Of the residents I trained with, she is one of the few still practicing traditional primary care. The rest of us have either hung it up entirely or moved into semi-related careers in urgent care, emergency medicine, sports medicine, aesthetic medicine, telemedicine, or clinical informatics. We were finally able to catch up this week and dish a bit about the healthcare landscape in our fair city.

We both initially worked for Big Health System, both in start-up practices in relatively underserved areas where the economics proved to be unsustainable. I felt a little guilty because she was a year behind me in training and I had recruited her to work in a practice situation that was similar to my own, and because neither of us could ever “make it” given the economic model used by the health system. Typically, a newly employed physician is on a salary guarantee and is expected to break even in the first few years of practice. At the time, hiring hospitals were offering modified “eat what you kill” salary arrangements, which if you did the math academically using average reimbursement for the area, seemed very doable.

Despite being more savvy than some of our peers, both of us wound up in the same trap as far as payer mix. As straight fee-for-service providers, we were negatively impacted when both local auto plants closed and many of our patients lost their jobs along with their well-paying insurance.

I had already been forced to limit the number of Medicaid patients I saw after coming to the conclusion that having 30 percent of my panel leading to reimbursements of $24 per visit wasn’t going to be economically sustainable. I did make exceptions for patients who were already established, but wasn’t taking new Medicaid patients, which created a crisis of conscience for me as I was caught between economic realities (getting off that guarantee so I could start paying back my student loans) and caring for people as I thought I had been called to do.

My employer was ill-equipped to deal with self-pay patients, barely offering a discount and making it difficult to care for people who didn’t have solid commercial insurance or Medicare. Although my visit numbers and my billings were great, my collections were terrible, and I was faced with a steep drop in salary at the end of my guarantee period.

Digging into the finances revealed the fact that my employer was charging the costs of building my office against my practice’s cost center, which although not specifically mentioned in the contract, was apparently allowable. Had I taken the easier route and joined an existing practice with no build-out required, I wouldn’t have had any construction costs attributed to me and the cliff I was about to fall from would not have been quite as high. Fortunately, my colleague had gone into an existing space while her office was under construction, so she wasn’t getting hit with the build-out costs and had time to maneuver before her guarantee ran out.

Meanwhile, we were watching our friends who had gone out into affluent communities beat the guarantee in barely over a year since they had a stronger payer mix and fewer patients with public aid and bad debt.

I was offered the opportunity to transition to clinical informatics, working a bit of urgent care on the side. She didn’t have that option, so she terminated her contract and decided to take her chances with the non-compete clause and work urgent care while she looked for a full-time position. She was quickly snapped up by a rival health system, who offered her a position outside her non-compete radius and with a better compensation plan.

Her new employer had realized that they weren’t going to be able to recruit physicians into relatively underserved areas (her new position was rural) without finding a way to make the finances work. This organization used more of a RVU-based compensation model, where physicians were paid more equitably based on the work they did rather than by their payer mix. They also had more of their salaries attributable to quality scores. Looking back, they were much more on the forefront of pay for performance than we had been at Big Health System.

Fast forward more than a decade. She is still in the same practice, but coping with the ups and downs that many physicians do. First, there was the EHR conversion to Epic, which created a lot of upheaval and several years of slow progress while the system tried to synchronize content and features across a multi-state environment. Then, there was the birth of Meaningful Use and its respective pains and the rise of Patient-Centered Medical Home and other incentive programs, all of which put stresses on providers. She and her partners are trying to have a semblance of work-life balance when they’re being asked to better engage patients by providing expanded evening and weekend hours, by delivering after-hours telemedicine services for their regional physician group, and ensuring their quality numbers are at the top of the scale.

At her age, she should be a good two decades from retirement, but she’s seriously contemplating a change now. In addition to the challenges already mentioned, she cites her biggest struggles as low health literacy and socioeconomic issues – but the challenges are at two different ends of the spectrum.

At one end, there is the stereotypical situation where patients lack education about health-related issues and lack the means to address some basic needs. She has patients in her semi-rural community who struggle with food insecurity, transportation issues, lacking support systems, and more. At the other end are relatively affluent patients who have been streaming into the community to take advantage of inexpensive housing and who have much more economic means. However, they have similar levels of low health literacy, but due to insurance coverage and the perceived need for services, rank as “high utilizers of healthcare” similar to their lower-status peers.

She finds the latter group more frustrating, as they seek care for many conditions that could be treated at home and with over-the-counter remedies. They tend to use urgent care and retail clinics for convenience, demand care within hours of having any kind of symptom, and often want tests performed when a history and physical would reveal the answers. She’s tried to get many of them to use the after-hours nurse line rather than urgent care or the emergency department, but hasn’t been successful, leading to increased work handling coordination and transition of care issues the next time these patients present to the office.

We talked a little bit about moral distress. With one group, she feels she is delivering poor care because they lack resources. With the other group, she perceives the care as poor quality because it’s fragmented and sometimes the patients frankly receive too much care. It seems that dealing with these polar opposite situations adds stress of its own, with too few solutions in sight.

For a while, she entertained the idea of direct primary care or a retainer practice, where she could define the terms of care as part of the agreement, but was not willing to give up serving her less-economically advantaged patients. She’s been having thoughts about trying to start some kind of educational foundation or organization that would specifically target health literacy and appropriate care issues, but it’s hard to find seed money for something like that, especially when one of your constituencies is well off.

We talked a bit about the idea that “too much care” is relative, that as we empower patients, it’s up to the patients to decide whether they’re receiving too much (or not enough) care and to decide when, where, and how they want to engage with caregivers. It’s a tough spot to be in, especially when you’re trying to manage a business, raise a family, and control your own stress level.

I didn’t have any good advice for her other than to validate her feelings and talk about different approaches I’ve seen in my travels. It’s a shame that a physician with so much to offer feels like she is at a crossroads like this, with few choices when she still has a potentially long practice career ahead of her. The health systems in our community tend to suffer from shiny object syndrome, ranging their attention from telemedicine to school-based clinics to medical home to employer-based clinics to retail clinics and beyond. Neither of them seem to be acting very strategically, which adds to the madness of the system.

What we’ve arrived at is a two-tier system without admitting it. There’s the “public” safety net system and the “private” alternative for those who can afford insurance. We pay lip service to quality and value-based care and the providers and other clinicians are caught in the middle somewhere.

I’d love to hear from people in progressive healthcare systems or delivery networks how they’re addressing this and whether they can make it work, keeping all of the parties engaged and reasonably satisfied (at least enough to keep them at the table). Have you figured out how to keep primary care physicians from leaving practice before they hit the tender age of 50? Do you have an answer in your Magic 8-Ball? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Helen Waters, EVP, Meditech

Helen Waters is EVP of Meditech of Westwood, MA.

Tell me about yourself and the company.

I’ve been with Meditech for 28 years. I previously worked in the software industry for a financial software company. I’ve held various positions in the last 28 years. I’ve spent a lot of time in the field working with customers and selling to customers. I had an operational vice president position for our legacy products of Magic and Client-Server, where I managed the development, implementation, and client services for those customers for about five years. I was promoted to executive vice president about 24 months ago. I’m an officer of the company. I’m involved today in its strategic direction and vision along with some of my peers here at that level. I’m happy to be talking with you.

With regard to Meditech, it’s a 50-year legacy in an industry that we’re very passionate and excited about, in terms of the future of what we’re doing and where the industry is headed.

How much of Expanse is newly developed and how does it differ from previous offerings?

Expanse for us represents the development over several years of an EHR that we designed for the post-Meaningful Use era. Major components of it were written from the ground up, enumerating many, many modules. In particular, the entire physician experience, in addition to introducing an ambulatory system, which prior to that time, we had not built on our own. We have spent a lot of time building out the provider experience to a different level of clinical sophistication in that tool set. Rewriting many, many modules within it so that it’s a Web-based system accessible through a browser and a completely tap-and-swipe experience as it relates to the provider encounter for any element of providers engaged in ordering, documenting, reconciling, and reviewing the record. That’s ambulatory, acute, and the emergency area.

The company was late to recognize the demand for an integrated ambulatory system in partnering with and then acquiring LSS. It also wasn’t very public-facing in just plugging away quietly, even skipping the HIMSS conference one year. What triggered the realization that the strategy that had worked so well needed to change?

Very fair comments on all fronts. We had recognized the need for an ambulatory system that would be built and driven by us in an integrated fashion. I would put it in the context of 2007 and 2008, when a brand new user experience was introduced to the world by Apple. I would say that by 2009 and 2010, we saw that gripping hold of the consumer landscape pretty extensively. The IPad came out in 2010. We saw a tremendous opportunity to start to envision where we wanted to end up at the end of MU.

The company itself was realizing all of its success factors over many decades, but also identifying the need to retool the company for this next chapter that we want to write. The technology was moving very fast in terms of that user experience. We saw that as taking hold. At the time, we realized that we had an opportunity to differentiate this next half-century for Meditech by taking that user experience that we were used to in other levels of our life in tapping and swiping and remove the hindrance of clicking, scrolling, and digging.

We saw an opportunity in 2011 and 2012 to build a brand new EHR, and in particular, emphasize the provider experience. We started with the ambulatory system. We had a lot of great choices then. I think everybody knows we owned LSS, which was successful for a period of time, but we at that time hit a pause button and said that we wanted to come out with something that was better, more integrated, and perhaps more transformational than what we saw in the market at that time. That’s when we hit the pause button to build the ambulatory system and bring that web platform out into general release in the market in 2016.

How is the hosted system market developing and how is Meditech responding?

Our entire Expanse platform is driven off of browser access. We no longer require complicated mechanisms to log on to our system. Our entire physician experience requires just a mobile device and a browser of their choice to get into the system. There’s a lot of discussion we could have about the importance of the security around that, but these systems are cloud hosted and cloud based.

In addition to that, we announced as a company in 2017 the availability of Meditech fully as a service, initially offering it to critical access facilities. We recognize the many challenges facing our customers and certainly smaller organizations in procuring systems, deploying them, and maintaining and managing them. We wanted to take an opportunity to deliver an all-encompassing solution for that market and a cloud-hosted service, soup to nuts, in a standard offering for the critical access hospitals to start. Scaling up from there now to the community hospital environment.

The company’s annual revenue and income took a steep slide from 2013 to 2016, but  turned back up in 2017. What caused that trend and why is it improving now?

The market, in our opinion, is still to a degree in a state of flux. There are major established players in the EHR space. Three of them encompass over 80 percent of the market. We’re fortunate to be one of those. The market has witnessed a tremendous amount of consolidation. There continues to be heavy pressure in the form of the fiscal realities of healthcare, the changing reimbursement models, the fact that our customers or all customers are being pressured with cost containment management and the fact that the nation as a whole is still striving to see the cost of healthcare go down and that has not yet been realized.

The introduction of a platform that was designed for today’s healthcare paradigm versus the one that was in 1990 or 1980, for that matter, with Magic. Introducing a system that was built around an environment that had shifted massively because of Meaningful Use has made people sit up and take notice of Meditech. The legacy of this company and its commitment to healthcare, and more so its commitment to solving problems with this industry in the spirit of partnership, in addition to a very contemporary system and one that is still affordable. We think that that’s an important point, to underscore that the value proposition in what we’re delivering. That has caught the attention in the market. Contemporary tools, modernized for today’s user experience the way people expect and should demand. Very deep and functional capacity in terms of advanced features, but still acquired, maintained and sustained affordably. That’s critical for healthcare today and that has helped the market start to readjust itself down.

It’s long been an assessment made by the market that if you paid a ton more for software, you got a lot more. Over the last eight years, we’ve seen the industry go through massive amounts of investment, yet we wake up at the end of that investment and we have a high physician frustration factor, a high burnout factor. We have yet to see real economies of scale in terms of the consolidation in the market, truthfully, in terms of provider organizations or price points. The market is ripe for new technology, new discussion, new context. That’s why you’ve seen an upturn.

Why more conversation about Meditech in general? One of the things that I realize with a deep level of experience and passion for this company is that having a cone of silence really didn’t serve the market or our customers well. A few years ago, we decided to be comfortable in our own space of putting our company into context, making a determination that we were here with a purpose and a passion for what we do. Unequivocally, we do it as well if not better than most. We had a very strong intention to continue to play a significant role in this market, so we made a decision to be more comfortable in those conversations, to be more open about them. At one point in time, I don’t know that we spent a lot of energy and investment there. We’ve identified the need for that. This is a whole different world. This is a very different company.

Most people will recognize us without question in terms of the core value structure and the emphasis and principles that we still maintain. But this is a company that has clearly evolved both inside and externally to the market, and that’s been well received. We’ve been humble enough to realize that the success factors that made this company great over the last 50 years will continue to need to be retooled and evolved for the market that we’re in today and for the customer that we’re trying to satisfy the needs of today. Very different.

How are non-profit hospitals looking at the role of cost and value when they make EHR decisions? Their for-profit counterparts mostly aren’t buying Cerner and Epic with contracts worth hundreds of millions of dollars.

I’d like to say that I hope that they stop, pause, and think about it more than they have been. I like to say that this an industry where there is a me-too movement that because someone else bought it, it has to be good. We’ve been busy debunking that theory. As we sought to identify where our future was headed and what we wanted for ourselves, we studied a lot of data. We looked at CMS data. We looked at cost data. We did some comparisons of our customers to others. There was a great realization, an epiphany, that came to us. For an industry that was pretty well established and automated, including hospitals, what has caused the escalation of cost in this automation? It doesn’t make any sense to us.

We’re trying to get people to wake up to the fact that they should be educated consumers. That software, in particular, is abstract. It’s not a car. It’s not a house. They need to look at data that is generated by unbiased sources, CMS being one. At the end of these eight years, does any one vendor stand out in terms of key categorizations of readmission penalties, hospital-acquired conditions, or value-based purchasing adjustments? Our research says that there’s very little distinguishing characteristic associated with the EHR that’s driving that.

We’re out to have an honest discussion with the market about being an educated consumer. Recognizing that these dollars that they’re spending on EHRs are important to other decisions that they’ll have to make, to other investments that they’ll want to carry forth, on capital resource, human resource, and otherwise. That they need to look at the results.

People have been responsive to that. You can’t open a digital media source without seeing some pretty difficult stories out there on the challenges of sustainability of these EHRs, the cost infrastructure, the staffing ramp-up, which is causing a lot of burden and in some cases, real heartache to organizations who’ve had bond degradings, layoffs, and other things happen as a result. We’re proud of our track record in maintaining the value discussion and partnering with the industry on taking the cost down, not driving it up.

How is Meditech’s market changing with hospital consolidation and the release of down-market offerings from Cerner and Epic that hit your sweet spot of smaller hospitals?

One thing I’d point out is that we do have a number of sizable IDNs in this country and globally. There are a collection of urban hospitals in the 200- to 400-bed range that also own and operate other facilities.

There’s no doubt that the urban academic medical center expansion and consolidation has been a challenge at times for us. I’m interested to see where this goes. The watchdog of our industry is starting to ask questions that we’re happy about in terms of, has the consolidation netted better higher quality for patients? More convenience, better pricing, and lower costs? There seems to be a lot of controversy out there right now, as to, does bigger necessarily dictate better?

Banking is a great analogy to that. The banking industry was consolidated. There were major players and the world was going to be better. It was going to be more affordable. Customers would be happier. There would be more convenience. A decade later, we see a lot of challenge in that industry. It didn’t necessarily prove to be better.

We’re watching the consolidation. We’ve built a robust interoperability strategy. I’ve seen less rip-and-replace in these last two to three years than we had seen previously. I’ve seen in some cases national not-for-profits and for-profits making decisions to consider two-vendor strategies. If you take the top 10 health systems in the country that might be listed as having a single EHR, I would comfortably tell you that we’re still present in all of those systems.

It’s an evolving conversation. The fiscal realities of making those decisions is causing people to pause. The market as a whole is looking at the impact of maybe too much consolidation and what that has done to healthcare, particularly in rural communities. There’s some really interesting lawsuits here and there where services were siphoned off over time. The facility may have been purchased and then people are driving another 50 to 100 miles to get basic services. There’s a lot of general controversy as to where this all goes in the future.

The interoperability messaging has been critical for us. We’ve seen it slowing down. We’ve seen more pragmatic thinking around that concept that rip-and-replace doesn’t always make sense. Interoperability, consolidation, a care management platform, and the ability to have a strong analytics platform that can be consolidated is more important. There’s a lot of innovation in those areas.

Do you have any final thoughts?

Healthcare is one of those unique industries that binds us together because we consume it. The combination of a highly agile technology sector with an evolving vertical market that’s moving with a company history and resume that’s pretty deep in experience is positioning us with renewed energy for the job that we have ahead of us. That is, to continue to participate in solving problems for customers and assisting on a national level with something that still has to happen, which is the reduction overall of healthcare spending as a percentage of GDP.

We’re enthusiastic about the next 50 years and beyond. We have purpose. We have mission. We have enthusiasm for the fact that this is a changing market and we’ve embraced the change as a company. We certainly have embraced the change in the platform. When you look at new concepts such as population health, reimbursement models evolving, artificial intelligence, and genomics, there’s a whole host of things that are going to continue to keep us very challenged and engaged. We are excited about that. I know that sounds corny, but we are. That fuels us every day.

Morning Headlines 6/4/18

IBM says it’s reaching for the ‘moon’ with Watson Health. That hasn’t stopped layoffs.

IBM acknowledges that last week’s layoffs affected a small percentage of Watson Health’s workforce, the rest of which will forge ahead with a new implementation project slated for Apollo Hospitals in India.

Intelligent Medical Objects (IMO) Announces Leadership Transition to Support Next Chapter of Growth and Innovation

Ann Barnes (MedData) joins IMO as CEO, replacing co-founder Frank Naeymi-Rad, who will become chief innovator and remain chairman of the board.

Illinois upholds Epic’s $62 million university contract

The Illinois Procurement Policy Board rejects Cerner’s challenge of the seven-year, $62 million Epic contract signed by University of Illinois Hospital and Health Sciences System.

Monday Morning Update 6/4/18

Top News

The Illinois Procurement Policy Board rejects Cerner’s challenge of the seven-year, $62 million Epic contract signed by University of Illinois Hospital and Health Sciences System.

The board had previously recommended cancelling the contract and letting the state executive ethics commission render an opinion based on Cerner’s complaint that its bid was lower, that it wasn’t allowed to demonstrate its product, and that the selection involvement of Impact Advisors created a conflict of interest since that consulting firm also offers Epic implementation and staffing assistance.

The procurement board realized that Epic had not been offered a chance to request its own hearing, and after listening to arguments from both companies, declined to pursue the matter further and will let the contract stand.

UIC executives said when Cerner filed its protest in December 2017 that it has had problems with Cerner as a current customer, that it has failed twice in trying to roll out Cerner ambulatory due to Cerner-admitted performance problems, and that Cerner failed its technical review and was therefore excluded from demonstrating per state procurement law.

UIC’s Epic project will replace systems from Cerner and Allscripts.

Reader Comments

From Norway José: “Re: Cerner in central Norway. It seems they’ve pulled out, assuming the translation is correct. Wonder if this is a sign of things to come as they turn their attention and resources to the VA?” The Health Center Norway RHF article says that Epic will get the contract after Cerner pulls out for unstated reasons.

From You Don’t Need a Weatherman: “Re: referrals. Interesting timing in light of the Steward case.” A case before the US Supreme Court regarding how antitrust laws are enforced may change how courts look at anti-steering provisions. The case involves credit card companies, but if the Supreme Court upholds a lower court’s decision, hospitals and insurers would be allowed to include anti-referral rules in their contracts. The AMA argues that physicians would be unable to send patients to out-of-network specialists even when they believe it’s in the patient’s best interest. 

From PitVIper: “Re: provider data. Humana, Aetna, UnitedHealthcare, ONC, SureScripts, VA, and other organizations got together and defined an industry roadmap to address issues in provider data.” A CAQH-convened group develops “An Industry Roadmap for Provider Data” in hopes of reducing the inefficiency created by inaccurate provider data. The groups involved will declare a commitment to the vision, form a governance structure, define an initial dataset and standards, engage regulators, and begin measuring impact.

HIStalk Announcements and Requests

More than 80 percent of poll respondents had a negative reaction to Cerner President Zane Burke’s labeling the DoD’s negative internal report on the MHS Genesis pilot sites as “fake news” that was influenced by an unnamed competitor in unnamed ways.

New poll to your right or here: who is most responsible for high US healthcare costs? Next week I’ll compare the new results from the same poll I ran a couple of years ago.

I received too few entries to last week’s question, so here’s one last try. I should note that I’m not looking only for negative answers with these questions even those are often in the majority.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

Following through on my long-ago promise to a reader to also recognize companies that have chosen not to renew their sponsorship, I’ll say thanks and goodbye to these companies that have left the HIStalk building since January 1:

• Conduent
• Dynamic Computing Services
• Ellis & Adams
• Encore Health Resources (acquired by Emids)
• Harris Healthcare (although it has added a sponsorship for its QuadraMed EMPI business)
• Haystack Informatics
• Healthlink Advisors
• Infor
• InMediata
• Lifepoint Informatics
• Protenus
• Sphere 3
• UltraLinq

Welcome to new HIStalk Platinum Sponsor Ciox Health. The Alpharetta, GA-based company facilities and manages the movement of health information with the industry’s broadest provider network, deploying capabilities in release of information, record retrieval, health information management, audit management, coding services and education, imaging services, clinical abstraction, and oncology data management. The company has 40 years of HIM experience and provides services to 60 percent of US hospitals, 16,000 physician practices, and 100 health plans. It manages 40 million requests for health information each year and complies with rigorous standards to ensure privacy and security. The company manages health information to support continuity of care, patient access to data, and reimbursement improvement. Thanks to Ciox Health for supporting HIStalk.

Here’s a Ciox Health intro video I found on YouTube.

I paid $65 to run the HIStalk email list through a third-party email validation tool that performs a deep dive into each subscriber’s email service. No wonder people say they aren’t getting my emails – a big chunk of company servers don’t let them through because of anti-spam systems, incorrectly configured servers, and readers who entered their email address wrong. At least I feel better telling people that the problem is on their end, not mine.

I also learned this by accident – if you export your LinkedIn connections from the Privacy menu, you’ll get an Excel file that includes every one of your contacts along with their job title, employer, email address, and connection date.

Thanks to the long-time readers who sent nice thoughts about HIStalk’s 15th birthday, some of whom were reading way back in my first lonely, fumbling year of 2003 (it’s still lonely and fumbling, but I accept it more readily).

Listening: new from Black Thought, aka Tariq Trotter, the genius co-founder and performer of The Roots. The lyrics are simultaneously angry, crude, and poetic: “Picture my daughter drinkin’ water with a sign; say ‘for colored girls,’ I ain’t talkin’ Ntozake Shange; Who said it’s cynical? I was a king and general; Rich in every resource, precious metal and mineral; Before the devil entered the land of the plentiful.” Lyrics are undervalued now that music is dominated by good looks, slick dance moves, and computer-enhanced songs written by someone other than the singer, but check out his freestyle rap from December to hear what Shakespeare might sound like if he were born 46 years ago in Philadelphia to parents who were separately murdered by the time he was 16.

I just finished reading the Theranos book “Bad Blood: Secrets and Lies in a Silicon Valley Startup.” Book report to follow.

Webinars

June 5 (Tuesday) 1:00 ET. “Increase Referrals and Patient Satisfaction with a Smarter ‘Find a Doctor’ Web Search.” Sponsors: Phynd Technologies, Healthwise. Presenters: Joseph H. Schneider, MD, MBA, FAAP, retired SVP/CHIO, Indiana University Health; Keith Belton, VP of marketing, Phynd. A recent survey found that 84 percent of patients check a hospital’s website before booking an appointment. However, ‘Find a Doctor’ search functions often frustrate them because their matching functionality is primitive and the provider’s information is incomplete or outdated. Referring physicians need similarly robust tools to find the right specialist and to send the patient to the right location. Attendees of this webinar will learn how taxonomy-driven Provider Information Management improves patient and referrer satisfaction by intelligently incorporating the provider’s location, insurance coverage, specialty and subspecialty, and services offered that can be searched via patient-friendly terms.

June 12 (Tuesday) 2:00 ET. “Blockchain in Healthcare: Why It Matters.” Sponsor: Quest Diagnostics. Presenter: Lidia Fonseca, CIO, Quest Diagnostics. Blockchain technology is gaining traction in many industries, including healthcare. It’s not only a hot topic, but is also showing promise with real-world applications. This webinar will share how blockchain may play a key role in the future of healthcare IT by helping to solve some of the industry’s challenges, distinguishing the hype from reality by discussing how it works, how it can impact healthcare providers, and its future application in healthcare IT.

June 21 (Thursday) noon ET. “Operationalizing Data Science Models in Healthcare.” Sponsor: CitiusTech. Presenters: Yugal Sharma, PhD, VP of data science, CitiusTech; Vinil Menon, VP of enterprise applications proficiency, CitiusTech. As healthcare organizations are becoming more adept at developing models, building the skills required to manage, validate, and deploy these models efficiently remains a challenging task. We define operationalization as the process of managing, validating, and deploying models within an organization. Several industry best practices, along with frameworks and technology solutions, exist to address this challenge. An understanding of this space and current state of the art is crucial to ensure efficient use and consumption of these models for relevant stakeholders in the organization. This webinar will give an introduction and overview of these key areas, along with examples and case studies to demonstrate the value of various best practices in the healthcare industry.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Sales

• Boulder Community Hospital (CO) chooses Epic.

Decisions

• Cumberland Memorial Hospital (WI) will replace Evident with Athenahealth on August 1.
• Caldwell Memorial Hospital (LA) switched from Healthland to Evident in September 2017.
• Faulkton Area Medical Center (SD) will replace Healthland with Cerner on June 25.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.

People

Curt Thornton (Capsule) joins Quantros as SVP of sales.

Intelligent Medical Objects hires Ann Barnes (MedData) as CEO. She replaces co-founder Frank Naeymi-Rad, PhD, MS, MBA, who will continue as board chair and will add the role of chief innovator.

Announcements and Implementations

Amazon Web Services announces GA of Amazon Neptune, a graph database that allows developers to query relationships to power social networks, recommendation engines, fraud detection, and drug discovery. A life sciences startup is using it to study disease by connecting genomics, pathology, neurochemistry, and device and patient clinical data.

A new KLAS report on HIT assessment and strategic planning finds that Cumberland and EMids Technologies (the former Encore Health Resources) are more consistent in exceeding client expectations; Impact Advisors and Chartis Groups excel at delivering high-quality outcomes across a large number of clients and projects; Nordic is the highest overall performer; and Accenture finishes worst as clients report less value obtained. The report highlights Nordic and Deloitte for thought leadership.

Other

A University of Michigan poll finds that half of older adults have set up a patient portal, with those aged 65-80 who haven’t done so saying they aren’t comfortable with technology while those 50-64 say their biggest barrier is that they just haven’t bothered. Respondents gave portals a slight edge in their ability to understand the information they’re given, but telephone contact with the practice won for the ability to explain what they need and also with the hope of getting a faster response.

In England, The Daily Telegraph looks at the digital revolution in healthcare, giving kudos to Epic-powered alerts for quickly detecting and treating sepsis at Cambridge University Hospital’s NHS Foundation Trust, where 80 percent of newly diagnosed sepsis patients are being given antibiotics within one hour. It also mentions the Pediatric Early Warning Score for escalating peds issues quickly. The article also quotes Eric Topol, MD, who is reviewing an NHS technology review and who predicts the end of expensive “hotel hospitals” as patients are increasingly monitored at home.

Australia’s new, $2 billion Royal Adelaide Hospital is spending an annualized $2 million to store and deliver paper medical records after the incoming new government pauses its Allscripts rollout. The health minister says the EPAS project is “hundreds of millions of dollars over budget and years behind schedule.”

A small poll finds that 88 percent of Americans aged 40 and over would be comfortable receiving care via telemedicine, although half worry that care could be of lower quality.

A tiny new study finds that doctors can predict which patients will do well on chemotherapy by looking at activity data from their fitness trackers. Those who are non-sedentary more than 60 hours per week seem to require fewer hospitalizations and ED visits.

Newly published research finds that many cancer patients could safely skip chemo and surgery without affecting their survival, including eliminating chemotherapy after surgery for early-stage breast cancer. 

Baylor St. Luke’s Medical Center (TX) temporarily suspends its heart transplant program following publication of investigative reports calling out patient deaths and surgeon turnover. Meanwhile, the hospital’s chief of staff says in a Houston Chronicle opinion piece that “these journalists will need to have a contingency plan to go to Europe or maybe the Cayman Islands” if they need cardiac care after the authors noted the high death rates of heart surgeon Bud Frazier, MD even though the hospital itself had found problems with his work years ago.

Apple announces Digital Health, which despite the name, is an app to help consumers wean themselves off their electronic devices by limiting their time online. Google has introduced a similar feature in its Android operating system that records the time spent within each app and allows the user to set time limits.

In France, two doctors face disciplinary action after getting into a fistfight in an OR after an anesthesiologist complains about having to work after 4:00 p.m. because the urologist’s case ran over. The anesthesiologist says the urologist threw a bottle of Betadine in his face, with the latter then going after the urologist with surgical scissors. They continued their fracas in the OR dressing room afterward, when the urologist is alleged to have smacked the anesthesiologist in the face with his computer bag, shattering his eye socket and requiring a month-long recovery.

Sponsor Updates

• Pivot Point Consulting’s Seattle team volunteers at the Hopelink food bank.
• Netsmart will exhibit at the NAPHSIS – Vital Records Annual Conference June 4 in Miami.
• Datica lists its milestones attained as it reaches its fifth anniversary.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Epic Michigan User Group Conference June 5 in Ypsilanti.
• OmniSys will exhibit at PioneerRx Connect June 7-10 in Nashville.
• Meditech will host  its 5.x/6.0 Revenue Cycle Summit June 26-27 and 6.1/Expanse Revenue Cycle Summit June 28-29, both in Foxborough, MA.   
• Quadramed will exhibit at the CHIA Convention and Exhibit June 3-6 in San Diego.
• Wisconsin Health News features Redox CEO Luke Bonney.
• Nordic reports that its score of 98.1 on KLAS’s “HIT Assessment & Strategic Planning 2018” report is the highest of all companies mentioned.
• WebPT announces the speaker lineup for its annual Ascend Summit September 28-29 in Phoenix, AZ.
• Access joins Athenahealth’s More Disruption Please program.
• Philips Wellcentive publishes a white paper titled “Is there a business case for value-based care?”
• ZappRx achieves HITRUST CSF Certification.
• The SSI Group earns certification under the HHS Optimization Program Pilot of Administrative Simplification.

Blog Posts

• How an Integrated System Can Work For Your Emergency Department. (Santa Rosa Consulting)
• Prior Authorization Software Benefits Patients and Providers (The SSI Group)
• Next Generation Healthcare Consumer Marketing Requires an Advanced Targeting Methodology (SymphonyRM)
• You don’t know what you don’t know. (Voalte)
• Reducing Alarm Fatigue and Interruptions: Clinicians See a Bigger Problem than IT Does (Vocera)
• Why corporate values fail to resonate (and how to make sure yours do) (Nordic)
• The State of Rehab Therapy in 2018 (WebPT)
• Clinical Process Improvement & Innovation in Care Delivery at #HIMSS18 (LogicStream Health)
• ED Utilization: Addressing the Ongoing Industry Challenge (Medecision)
• How one hospital prepared for the new home health conditions of participation (Meditech)
• Strong Physician and IT Collaboration Drive Organization Success (Medicomp Systems)
• Tending Your RCM Garden (Navicure/Waystar)
• Enhancing Autism Services Through Technology (Netsmart)
• Four Questions Series: Alex Binder, VP of Visiting Physician Services, Visiting Nurse Association Health Group (PatientPing)
• Are paperless bills suppressing your patient payments? (Patientco)
• PokitDok joins Hyperledger (PokitDok)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

Weed’s Legacy

Weed’s Legacy
By Robert D. Lafsky, MD

Robert D. Lafsky is a gastroenterologist in Virginia.

It’s been a year since Dr. Lawrence Weed passed on at 93. He got a mention in HIStalk and a longer obituary in the New York Times, where he’s credited as a major innovator in the organization and computerization of medical records.

He was. But reading his later work, one has to doubt that Weed would have been happy with the Times statement about his Problem Oriented Medical Record, that “two of its features have become nearly universal in health care: the compiling of problem lists and the SOAP system for writing out notes in a patient chart.” 

Oh sure, you can look at the average EMR chart these days and see a “problem list” and SOAP designations on at least some of  the progress notes. But do the problem lists reflect the sort of organized rigorous thinking and aggressive pruning he advocated as necessary to keeping them useful?

Not very often. Especially after several admissions, a hospital patient’s list has a long string of overlapping, duplicative, or clearly unnecessary subordinate “problems.” It’s of little use to anybody. And are the SOAP notes problem-specific and do they clearly divide up the information as intended and point toward action?

Don’t get me started. Let’s just say that if we revived Dr. Weed and turned him loose with a current day EMR and gave him an hour at the lectern, his critical dissection and ridicule of the clinical work therein would be strikingly similar to what he does in his famous video from 1971.

The key concept underlying the Weed scheme was that one doctor brain couldn’t hold enough information to organize information and make good decisions about a patient. The process needs a more systematic and documented approach. 

As obvious as that may sound to readers here, medical giants walked the Earth 50 years ago, and a Big Ego telling other Big Egos — especially specialists — that their egos were too big didn’t always go over so well. But there was a more fundamental problem and Weed had to deal with it.

The original Weed system made sense dealing with the management of known and established problems, but the “unknown unknown,” the diagnosis problem, was the flaw in the scheme. I saw this myself when I started practice as a specialist in the early 1980s in a then-hotbed of Weed methodology — a small hospital with young family practitioners trained on the POMR concept.

What I saw repeatedly as a consultant was that no amount of dogged problem list maintenance could get you to see that problems 1, 3, and 5 were actually components of a single syndromic diagnosis. You just had to know that. And in those days, without sufficient training in the field in question, the light bulb never went off over your head.

Actually that light bulb method is still what we’re doing, but Weed spent his later career working on a computerized improvement. A trained interviewer (not necessarily a physician) would work with the patient and the records to input extremely granular information in a neutral fashion, avoiding the leading questions that the current heuristic system requires. The computer would then go to work applying a series of “knowledge couplers,” what I believe would be considered an expert system in current terminology, to generate a complete list of diagnostic possibilities. Only after that would a physician start dealing with the case and sort out the problems in light of that information.

How did that work out? You can read Weed’s book for a very full discussion of his later views. But the business of the ensuing business enterprise is a checkered story. Here’s an article from 2002 about his system and its fate. Suffice it to say that this was not a system that took over the world.  

Is Weed doomed to be an obscure historical figure in medical history at best and a minimally successful software developer at worst? I’ve had conversations with very highly-placed medical people who had never even heard of him. But it’s hard to look at the current morale problem in medicine and not see him as a prophetic visionary. Every week or so, I see two or three “burnout” articles or videos, mainly focusing on the current EMR experience. Everybody complains that they now have two jobs, data entry and actual thinking, or at least trying to make the light bulb turn on.

Will a Weed-like diagnostic system take over eventually and automate the light bulb? The problem is it’s going to take a lot more time and disruption to get something like that working and working well.   

But in smaller but still important ways, Weed’s legacy can and should come into play right now. The Weed argument would be that this burnout crisis was foreseeable, a result of medicine never controlling the data design process in the first place. And we never developed an ethos that requires that everyone have the individual discipline to actually contribute value to structured data with rigorous truthfulness, regardless of specialty orientation. And then to rely on what’s in there, or if necessary, correct it. 

In particular, although specialists are necessary, they have special duty in a shared hospital EMR environment to pay attention to what’s in the data tables and not just churn out unstructured and often contradictory text reports. Detail management is hard but critical, and although details span a range of importance, failure (say, to get a fresh and confirmed cancer diagnosis on the problem list before discharge) should be considered somewhat above the misdemeanor level.  

The burnout crisis reflects a pervasive sense that medicine has lost its autonomy to business and IT interests. But a key Weed-based insight is that we can’t start to get it back without taking more responsibility for what’s gone wrong.

Weed can be seen to offer a tough but fair path off of the beachhead we seem to be stuck on. The profession as a whole can regain autonomy, but the individuals in it have to give up some of individual ego-tripping many in it have enjoyed for too long.

There’s great potential for a better software environment in the future. Weed’s legacy will be more clear to everyone in the future. Right now, we have to pitch in now to work better with what we have.

Weekender 6/1/18

Weekly News Recap

• France-based Withings buys back the consumer digital health business it sold to Nokia two years ago and will restore the brand to the market
• Providence St. Joseph Health modifies its EHR to store patient advance directives and display them to clinicians during care events
• IBM reportedly lays off a significant number of employees of its Watson Health business
• Orion Health lays off 177 employees and is rumored to be pursuing a sale of some or all of the company with unnamed parties
• Personal injury lawyers in Philadelphia are buying geofencing-powered advertising campaigns to identify smartphone users who are in hospital EDs and so they can solicit lawsuit business afterward

Best Reader Comments

Zane: HISsie 2018 nomination + a lock on “Biggest Sore Winner” in a one-horse race. (Another Dave)

Why is it that every time IBM announces another quarterly loss (is this the 25th or 26th consecutive quarter?) that the people who have been busting their tails for years are the ones who unceremoniously get let go while the people in leadership continue to collect their massive salaries and are pretty much immune to any excision-related actions? (Genteel Giant)

Are there really so few women or people of color who making newsworthy HIT career moves? (ellemennopee87)

Keeping current on industry trends is smart, and I think writing thoughts and trends down in your own words (versus just skimming) industry news, if even just a couple sentences a day or even per week, is a good way to stay current. (Kallie)

Practice Fusion is a little clunky in some areas, very slick in others, but the great thing about it is that it’s continually improving. Someone there really cares about users and keeps making the little refinements that make the physician’s day easier. Hopefully, whoever they are, they’ll stick around after the Allscripts acquisition! We’re paying the $100/provider/month for now and we’ll see how it goes. (Dr. Herzenstube)

Is Sutter claiming that there were not any adverse events due to all records of all patients having gone black in one fell swoop? Did any patients die from the delays in care? (Sandi Green)

Watercooler Talk Tidbits

Reader donations funded a three-day academic camping trip in the Santa Monica Mountains for Ms. V’s fifth grade class in urban Los Angeles. She reports, “The project made a world of difference in the lives of so many students such that they are able to have the resources that they need in order to be able to succeed in a natural learning environment. Going to fifth grade camp has been such an incredible experience for my students, not only for learning academic science standards, but also for learning how to work together. For some of the students, it’s the first time that they’ve ever spent the night away from their parents, and it’s truly special to be able to share this with them and their friends.”

In Canada, a Nova Scotia doctor says it’s not fair that the province has singled him out for enforcing its “no new EMRs” policy as it tries to implement a big-picture system in a project started years ago. He says he’s the only one of 15 orthopedic surgeons who is stuck using a paper-based system since his peers ignored the ban and implemented EMRs.

A private addiction hospital in Scotland opens a rehab program for people addicted to trading cryptocurrencies, mostly young males and casino workers. 

Documentary filmmaker Ken Burns gives Mayo Clinic a preview of scenes from the upcoming film he executive produced titled “The Mayo Clinic: Faith, Hope, Science.” It will air on PBS in September.

HBO Documentary Films is creating a film covering the rise and fall of Theranos.

A drug company rep who struggled to push its Subsys fast-acting fentanyl spray that costs $25,000 per prescription because patients were “already addicts” was told to literally beg pain management doctors to prescribe its drug, according to a newly unsealed whistleblower lawsuit. Salespeople report taking doctors to strip clubs and shooting ranges, posing as medical practice office staff to convince insurers to cover the prescriptions, and hiring a male doctor’s girlfriend once he agreed to “turn on the Subsys switch.” The former rep says her employer, Insys Therapeutics, hired a former stripper and escort service manager as a sales executive, along with another rep who was described by her boss as being “dumb as rocks” but willing to have sex with doctors. He described the ideal candidate for an open drug rep position: “A doctor’s girlfriend, son, or daughter. Banging a doctor, that would be perfect.” The company reportedly also developed a script to push reps into selling the drug for off-label uses and used a mail-order pharmacy that didn’t question prescriptions for excessive doses and quantities.

A small study of doctors in two safety net hospitals finds that providing emergency-only hemodialysis to undocumented immigrants contributes to the physicians’ professional burnout due to: (a) seeing patients needlessly suffer and die for non-medical reasons; (b) their lack of control over the treatment criteria; (c) the moral distress that results from seeing care decisions made for non-medical reasons and only after gaming the system; and (d) being inspired for advocacy. 

A New York gynecologist files a $1 million defamation lawsuit against a patient who gave him bad reviews of her one and only visit. The patient claimed that the doctor’s business practices are “very poor and crooked” on Facebook, Yelp, and doctor review sites after she was stuck with a $427 bill when he billed her insurance for a new-patient visit plus sonogram instead her covered annual exam. The practice says the doctor has to base his clinical decisions on patient need, he always gives new patients a sonogram, and it’s not his job to keep current on the intricacies of every insurance company. The patient claims that after the reviews, the practice publicly posted her entire medical record in retaliation. Dim-witted Yelpers reacted as they always do – they flocked to Yelp to leave their own scathing reviews of the doctor, making sure to include a hefty dose of ethnic insults because he was born in Korea. Scouting Yelp, the woman has also left lengthy, bitter one-star reviews for a dentist (“I don’t know why anyone would put up with this type of abuse”), a professional women’s association (“everything was not explained to me”), a gym (“I suffered a terrible trapezius injury”), and Fedex (“all of their services are a rip off in my opinion”). Maybe doctors need their own version of a doctor-shopper database to share information about patients likely to complain, lie, or sue. Meanwhile, nothing in this story alters my perceived reality that while I use Yelp regularly, it attracts more unintelligent, sour, and writing-challenged users by far than other review sites like Tripadvisor and OpenTable. Yelp desperately needs the ability for readers to filter out the results (and ratings contribution) of users whose reviews are consistently unhelpful or untrustworthy, especially those one-review contributors who are almost certainly company plants.

In Case You Missed It

• News 6/1/18
• EPtalk by Dr. Jayne 5/31/18
• Readers Write: Modern Practice: Automation and Lifestyle Management are Key Drivers for Growth
• HIStalk Interviews Ron Remy, CEO, Mobile Heartbeat
• News 5/30/18
• Monday Morning Update 5/28/18
• What I Wish I’d Known Before … Taking My First Job Managing People

Get Involved

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Morning Headlines 6/1/18

ClearBridge Investments Sends Letter to Board of Directors of athenahealth Inc.

Athenahealth investor ClearBridge Investments urges the health IT company to launch sale proceedings in light of a “litany of executive turnover, misexecution on several initiatives and persistent downward trajectory of a variety of financial measures.”

Withings will return after buying out Nokia’s health business

Withings will sell the Nokia Health products it re-acquired earlier this year, and relaunch the Withings brand by the end of 2018.

Propeller Health Raises $20 Million, Accelerating Development of Digital Medicines for Respiratory Health and Other Diseases

Propeller Health secures $20 million with help from Aptar Pharma, which will help the company scale its digital therapeutics beyond its core chronic respiratory disease market.

News 6/1/18

Top News

Athenahealth investor ClearBridge Investments jumps on the Elliott Management bandwagon, urging the health IT company to launch sale proceedings in light of a “litany of executive turnover, misexecution on several initiatives and persistent downward trajectory of a variety of financial measures.”

Reader Comments

From Only the Lonely: "Re: Allscripts. Getting ready to drop the bomb on vast swaths of employees. If you have a total of 60 years combining age and number of years with the company, you have been given notice to accept a early retirement package or else. Numbers said to be 500+." Unverified. I can say from past experience that the company won’t comment on personnel actions, so I didn’t bother to ask. The rumored effective date is July 1.

Webinars

June 5 (Tuesday) 1:00 ET. “Increase Referrals and Patient Satisfaction with a Smarter ‘Find a Doctor’ Web Search.” Sponsors: Phynd Technologies, Healthwise. Presenters: Joseph H. Schneider, MD, MBA, FAAP, retired SVP/CHIO, Indiana University Health; Keith Belton, VP of marketing, Phynd. A recent survey found that 84 percent of patients check a hospital’s website before booking an appointment. However, ‘Find a Doctor’ search functions often frustrate them because their matching functionality is primitive and the provider’s information is incomplete or outdated. Referring physicians need similarly robust tools to find the right specialist and to send the patient to the right location. Attendees of this webinar will learn how taxonomy-driven Provider Information Management improves patient and referrer satisfaction by intelligently incorporating the provider’s location, insurance coverage, specialty and subspecialty, and services offered that can be searched via patient-friendly terms.

June 12 (Tuesday) 2:00 ET. “Blockchain in Healthcare: Why It Matters.” Sponsor: Quest Diagnostics. Presenter: Lidia Fonseca, CIO, Quest Diagnostics. Blockchain technology is gaining traction in many industries, including healthcare. It’s not only a hot topic, but is also showing promise with real-world applications. This webinar will share how blockchain may play a key role in the future of healthcare IT by helping to solve some of the industry’s challenges, distinguishing the hype from reality by discussing how it works, how it can impact healthcare providers, and its future application in healthcare IT.

June 21 (Thursday) noon ET. “Operationalizing Data Science Models in Healthcare.” Sponsor: CitiusTech. Presenters: Yugal Sharma, PhD, VP of data science, CitiusTech; Vinil Menon, VP of enterprise applications proficiency, CitiusTech. As healthcare organizations are becoming more adept at developing models, building the skills required to manage, validate, and deploy these models efficiently remains a challenging task. We define operationalization as the process of managing, validating, and deploying models within an organization. Several industry best practices, along with frameworks and technology solutions, exist to address this challenge. An understanding of this space and current state of the art is crucial to ensure efficient use and consumption of these models for relevant stakeholders in the organization. This webinar will give an introduction and overview of these key areas, along with examples and case studies to demonstrate the value of various best practices in the healthcare industry.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

Withings co-founder Eric Carreel plans to sell the Nokia Health (née Withings) products he re-acquired earlier this year, and to relaunch the Withings brand by the end of 2018. The company still employs 200 at its headquarters in France.

Omada Health becomes the largest Diabetes Prevention Program provider to achieve full recognition status from the CDC. Founded in 2011, the company has raised $126 million to develop and market a technology-based diabetes management program for employers and payers.

Ovulation-tracking wearable company Ava raises $30 million in a Series B round, bringing its total raised to just over $45 million.

Madison, WI-based Propeller Health secures $20 million in a funding round led by Aptar Pharma. With help from Aptar, Propeller Health plans to scale its digital therapeutics beyond its core chronic respiratory disease market.

People

Voalte hires Keith DeYoung (Wolters Kluwer Health) as VP of sales.

Alan Stein, MD (Hewlett-Packard) joins medication risk management technology vendor Tabula Rasa Healthcare as SVP of healthcare analytics.

Announcements and Implementations

After a successful pilot last year during Hurricane Harvey, UTHealth’s (TX) physician group will offer the Babyscripts prenatal remote monitoring app to all of its pregnant patients.

Premier launches a new collaborative to help health systems navigate physician practice acquisitions.

Robin Healthcare announces GA of an Alexa-like device for orthopedics and other specialties that uses machine learning and natural-language processing to capture physician notes and add them to the EHR.

Fitango Health develops care management and patient engagement software for oncologists.

Hyland debuts new enterprise imaging solutions including PACSgear Image Link Encounter Workflow and upgrades to its NilRead enterprise viewer.

Samsung will embed video visit and symptom checker capabilities from Babylon Health within its Health app on Galaxy devices sold in the UK. Babylon, which powers the NHS “GP at Hand” telemedicine service, hopes the deal will propel it beyond British borders should Samsung decide to expand the partnership beyond the UK.

Sales

• Capital Regional Medical Center (MO) selects Infor’s CloudSuite Healthcare and Cloverleaf Clinical Bridge software.

Privacy and Security

Several Aultman Hospital (OH) employees fall prey to an email phishing scam, resulting in a late-March data breach that potentially exposed patient medical record, driver’s license, and Social Security numbers.

Other

This article highlights the blind-like trust consumers put into Ancestry.com’s DNA testing services, despite the secretive nature of what the Utah-based company does with biological samples after it sends customers their ethnicity profiles. Ancestry has expanded its DNA database to include samples from over 5 million people, and won’t reveal where it stores the DNA or how long it will be kept. “Right now they see the benefit as being able to have cocktail-party conversation about their genetic makeup,” says former FDA commissioner Peter Pitts, who now heads up the nonprofit Center for Medicine in the Public Interest. “They aren’t thinking about the risks of giving up their personal information, and the long-term implications.”

A literature review of HIE studies finds that community HIEs do indeed reduce healthcare utilization and associated costs, especially in the areas of duplicate procedures and imaging. The finding contradicts a 2015 study that found few HIE benefits in similar areas.

Laurent Duvernay-Tardif, MD becomes the first active NFL player to graduate from medical school. The Kansas City Chiefs right guard hopes to add his new honorific to the back of his jersey.

A study conducted by researchers at the University of Virginia using software from National Decision Support Co. finds that radiology trainees are more apt to select appropriate imaging studies when aided by clinical decision support technology from within an EHR. CDS utilization in turn helped to reduce unnecessary imaging and related costs.

A KLAS report on HIT assessment and strategic planning recognizes Nordic as the top overall performer.

Weird News Andy points out that high-profile donors don’t guarantee great outcomes: An elderly dementia patient is found dead in the stairwell of the Zuckerberg San Francisco General Hospital’s power plant. The woman had gone missing from a nearby mental health facility 10 days before. The hospital experienced a similar tragedy in 2013, when a patient was found dead in a stairwell two days after being admitted.

Sponsor Updates

• Medicomp Systems publishes a new infographic, “Phoenix Children’s By The Numbers: Enhancing Patient Care, Increasing Physician Productivity, and Saving Big with Medicomp’s Quippe.”
• A.T. Still University of Health Sciences will use Aprima’s EHR as part of its grant-funded falls risk assessment and prevention program for older adults.
• EClinicalWorks will exhibit at Digestive Disease Week 2018 June 2-5 in Washington, DC.
• FormFast will exhibit at the California Health Information Association Convention & Exhibit June 2-6 in San Diego.
• Healthwise will exhibit at the Cerner North Atlantic Regional User Group Meeting June 4-6 in Grantville, PA.
• Impact Advisors promotes Kevin Gately to principal advisor and Molly Ekelof to senior advisor.
• With help from Engage, Island Hospital (WA) wraps up initial implementation of Meditech Expanse.
• Gainsight recognizes Imprivata for customer success excellence.
• In New Zealand, MercyAscot selects the InterSystems TrakCare EHR.
• Mobile Heartbeat VP of Professional Services James Webb will speak at Cisco Live US 2018 on June 13 in Orlando.
• CTG consolidates several of its enterprise information management services into a single solution dubbed EIM Advantage.
• Salesforce invests in Virsys12, a healthcare-focused Salesforce implementation and consulting company.
• Datica celebrates its fifth anniversary as a cloud-based compliance and security company.
• The SSI Group achieves HHS Optimization Program Pilot of Administrative Simplification certification.

Blog Posts

• ADHD and Telemedicine: A Natural Fit (EClinicalWorks)
• Unlock the Code to a Better CDI Program (HCTec)
• Another Trip to the Hospital (Healthfinch)
• 3 Ways Content as a Service Helps You Win at Social Media (Healthwise)
• Don’t ignore encounter-based medical images (Hyland)
• The Walking Gallery – My Sepsis Story (Iatric Systems)
• 5 Secrets to Healthcare Content Marketing Success (Influence Health)
• Crossing the Payer/Provider Chasm – Getting to Shared Risk, Shared Data (InterSystems)
• Laying the Foundation for Enhanced Patient Access: The Importance of Analytics (Kyruus)
• The Real-Time Enterprise is Coming – Are You Ready? (CTG)
• Why corporate values fail to resonate (and how to make sure yours do) (Nordic)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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